RF_COM_H_48_A_SUDHA.pdf NEW.pdf
Media
- extracted text
-
f
RF_COM_H_48_A_SUDHA.
NGO FORUM FOR HEALTH
------ partnering, to make lie aft k a rea (itu ----and j-uitice in lieaftli care —
promoting e g ait g
a
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
• Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
• It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
• Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
/ 5
Organisation:
<S c 16 ^ c £_
F o c \j (^\
\/)G
Address:
h
.
o i
733
Telephone number: ,
|
)
Fax number:
Oty I 'b
E-mail
- 2. St 3 c, t
CO. /cL
C-'vA ,
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
Tel. (41-22) 798 54 00
NGO FORUM FOR HEALTH
------ partnering, to male
maLe lea
li a reafitg -----lie a ft k
------ promoting egaitg and justice
j. a it ice in keaftk care —
I. WHAT ARE THE INEQUALITIES IN HEALTH IN YOUR COUNTRY
a) What are the inequalities and inequities in health in your country?
Consider, for example:
- are certain groups particularly disadvantaged in terms of health provision based on class, caste,
gender,
race, ethnicity, sexual orientation.
- are there socio-economic and geographical differences in health indicators such as mortality,
morbidity rates etc.
- are there socio-economic and geographical differences in access to health care
- are there socio-economic and geographical differences in the resources spent on health care
*
MuvkxJ.
'fUc
1^^ /
l
^\fVx/^v z'
id
1'^ a
r
1^-
(
tnrtz '
b) Implementation of treaties, conventions, plans of action etc.
Is the Government fulfilling commitments made in international agreements such as WHO Health
For All strategy or the health provisions of the various international conferences of the 1990s such
as Rio, Copenhagen, Cairo, Beijing etc.
1U
Kub1-
rn O'
o
z^/
£
i
/
tvi
XASVkZ’'-
M
G 'A
/Q
de (/^jd
' l,vv^ 6bv^-/(_zZ<Xl-^
5
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
E-mail: wvi.gva@iprolink.ch
Fax (41-22) 798 65 47
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
I
NGO FORUM FOR HEALTH
re a ti t
------ partnering, to ma Le ke a (th a rea
---
keaftk care —
in keaftk
promoting eguitg and justice in
c) Are there any specific examples where these inequalities are being compounded by other factors
such as the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
0
- />O^07/ .
2. HOW WOULD YOU MEASURE THESE INEQUALITIES
a) How would you show that these inequalities exist?
o
b) Which sources of data and information in your country can be used for monitoring?
c) What about the accuracy and transparency of Government data?
. d/^it
d) Is there a need for a primary collection of data or would it be possible to analyse existing data?
T>.
/9
a rx
i
c
e) How is it possible to gain access to this data?
|
Oh
/9
tA.
4
A
(
G
?
o'/tx
x Xj
«
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
a
NGO FORUM FOR HEALTH
to make
— p artnerin
lieaftli a reality. ------
and justice in lieaftk care —
promo ting.
f) How will it be possible to verify if the data is reliable and accurate?
c
g) Is there a need to protect sources and is so how?
h) Who would monitor the data and how?
i) What are the cost implications?
Pvi
I o.
*
ivK
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
b) How can these issues be taken up?
4
G
<
c) With whom should they be taken up?
6i
1
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
.P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
(5^
NGO FORUM FOR HEALTH
make lieaftli a rea—
— partnering, to
and justice in heaftli care —
p romoting eguitg
d) What is the likely impact of such initiatives?
o
Ae
z. Ts
\^J
I.- ,
A'7
e*
e) Is there a need for a alternate reporting system whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
b) What different roles could they play?
5. ORGANISATION
a) How would a national watch be organised?
Lt
c
6 Xi
<S Ow—
/r^QO
! rJCO b.
o'—
-
(
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
------ partnering, to make lie a tt k a re a—
ma
- promoting equity, and fjaitice
mt ice in health care —
eci
b) What should be the structure?
vs
-ftc
Wzxj
/vl Zc . i
6
ILl C*
dr
HIa /Cz ) P
c) How should it relate to a global health watch?
d) How should the capacity of national and local NGOs from the South be
strengthened?
e) How can a wide, sustainable and independent funding base be maintained?
6. All the above questions have been related to a National Watch, watching
nationally. Do you have any suggestions of how a National Watch can also
feedback on global economy, issues, processes and projects that affect National
Policies ie., South-North dialogue - to whom and how?
7. ADDITIONAL POINTS
Have you got any other points you would like to raise either from a global or national
perspective regarding the creation of a Global Health Watch?
(5;
■ dLe.
i
c
RETURN TO:
Dr. Ravi Narayan,
Community Health Cell,
Society for Community Health Awareness, Research and Action
No.367, 'Srinivasa Nilaya' Jakkasandra I Main, I Block, Koramangala,
Bangalore - 560 034.
Phone : (080) 553 15 18 & 552 53 72
Fax : (080) 552 53 72 Email : sochara@vsnl.com
'H
. , • //
NGO FORUM FOR HEALTH
to
make ke a (th a rea t
---O ma
a 3 lice in keaftk care —
------- promo tin^ equity, and j.justice
— partnerinj
6. All the above questions have been related to a National Watch, watching
b) What should
the
nationally. Do youbehave structure?
any suggestions of how a National Watch can also
feedback on global economy, issues, processes and projects that affect National
Policies ie., South-North dialogue - to whom and how?
g A ' c ^4
c) How^should it relate to a global health watch?
d) How should the capacity of national and local NGOs from the South be
strengthened?
e) How can a wide, sustainable and independent funding base be maintained?
7. ADDITIONAL POINTS
■I
Have you got any other points you would like to raise either from a global or national
perspective regarding the creation of a Global Health Watch?
RETURN TO:
Dr. Ravi Narayan,
Community Health Cell,
Society for Community Health Awareness, Research and Action
No.367, 'Srinivasa Nilaya' Jakkasandra I Main, I Block, Koramangala,
Bangalore - 560 034.
Phone : (080) 553 15 18 & 552 53 72
Fax : (080) 552 53 72 Email : sochara@vsnl.com
I
f
i/
NGO FORUM FOR HEALTH
---- - ft ar t n& r i n y io ma he health a rea [itij ----— f.? ru mo I in 0 14 i I and judlice in
in health care —
(nniuL mcAi/m waicii
COCN'I RY Sl tJhiKS
OuesUonairc for participants attcndinji national meetings on the establishment of a Global
Health Watch
Please lead the. background papei altachcd which looks al the issue from a broad perspective
and gives general thoughts on the need, and prospects for setting up a Global Health Watch.
It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would cairy out its work.
It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation fo/ the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheet', if necessary.
©
Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
Organisation:
A s) AR^'T'M A-Wl
^AjVrS A
Address:
Telephone number:
c wiLH
I
Q>
OLvi'H
I
\/ GLLO0J&
7
‘-t'o i. ref
Fax number:
E-mail
viarn (a), hcs-tvvtai (
Od)tV) -
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallatl, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-2.2) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha'i Intoinational Community, 15 rto. des Morlllons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22)798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
WUU fokum
P ar tnerina
i■ > •.<’
t
cr; / i ncy. etj tt. i. /
FOR HEALTH
h e a /th a
a. /i I ij----a rree a
and justice in
health care —
i n health
hl a I? e
h VV?L\T ARETI.IE JNEQUAth Lh: • ?N HEALTH IN YOUR COUNTRY
• -;ii aic Hie inequalities and ineqmdcs m health in your country?
■ <?! ■cider. J or x amp Io:
c<-d.'uii i-mups pmticularly disach h )!.:-! J in lei ins of health provision based on class, caste,
-ace, r.lhniciiy, sexual orientation.
;m dicrc socio-economic and gcogranl lii <ii differences in health indicators such as mortality,
■' i
rates etc
nvac socio-economic and geographical differences in access to health care
c ■_ tibjtc sochj .economic and geographic d differences in the resources spent on health care
c Lajtw
J^
.
GU-a
(■ Lt V Js
Gvj VJG
Ak
C\tv -7x a ft Al.
c) implementation of treaties, conventions, plans of action etc.
• ue (.government fulfilling commitments made in international agreements such as WHO Health
• ’ ^hafegy or the health provisions of the various international conferences of the 1990s such
f(m? Copenhagen, Cairo, Beijing etc.
C?
dcOdjAji
A_'Vxp’ljl/bv^cct
<Xc\&<Xc\A-
AAa . cLxb tkjbr ixA
Aaa
z,( .
r.
■a,
-r,..;
CkV\
CMcfA
Contact addresses:
.,o. 7^,.. ,. no
p-°- Box 3'A '-h-lzl 1 Geneva 19 Switzerland
733 03 95
1 u
. Pi*
E-mail: mahallatOifrc.orq
V ’^ry. C/O Baha’i ini . /« << n Community, 15 de. dos Morillons. CH-1218 Grand-Sacconox.
•' J (41 :.', j 7!'ih !ri 'K!
' 'V' li.’eil-iiid
1 ' ) 798 55 77
E-mail: gballoiio^mp■.-nova.biG.oiq
NGO FORUM FOR HEALTH
— r ar I tie rinej. to rnciL a heal t k a re a titu
---
---- p r o fn o ting, equitg and justice in kectUlk care ----Arc there any specific examples where these inequalities are being compounded by other factors
; h as the activities of private sector organisations, corruption and inefficiency in health
•. nagement, lack of public accountability, unequal allocation of health resources
er
L\>vJ/veA_. Cl Ct (J_4
0X0 VKK/Vdl .
iz>
AA
VVCxtU
(Ju
U?
/Lcut^
2. BOW WOULD YOU MEASURE THESE INEQUALITIES
a) How would you show that these inequalities exist?
—
XcKxi
lu ptVC s
duo cJpw
—
'Qca £\jc ^1v
Hal
K/VlVM IA
Ua
WlAM
—
b) Which sources of data and information in your country can be used for monitoring?
11 “
.
■^(W
-s .1 x.^AAA^Jl
W^Oc LUa
Q u A1(ju H/UV
c) What about the accuracy and transparency of Government data?
— \l
cvua Jul Vv
rywzKAi) Uop ,
d) Is there a need for a primary collection of data or would it be possible to analyse existing data?
c) How is it possible to gain access to this data?
Contact addresses:
Dr. trie. Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva Switzerland
ai 7eL jT;2?? t79-? 41 83
E-mail: wvi.gva@iprolink.ch
.
Fax <41 *22)798 65 47
! .‘.niez.a k.anailati, i leasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
^ O. Box 372. CH-1211 Geneva 19 Switzerland
t
I h .I. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
.-H Giovanni Balleno, becretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) Zt”
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
•t 'nV
------ p cert ne r i n tj
ii t AL 1 H
a W k
IT K>; H. w k' m
•«»«<*
ma he he a ^t!v a reality. -----un (I J. a 3 lice in lie a fill care —
f
p ro mo tincj e ij. u i /
ncJ
1 Gw will it be possible to verify if the data is reliable and accurate?
JV>
Uo>cv(\ o
Fogjli »
6a , AV
t/vb^ict
(/V 4wd
6Uj LA7
d) Is there a need to protect sources and is so how?
Ca _J2__
4
£xa
h) Who would monitor the data and how(
\K v -}jwv^7
Nd C\G)
U Al.
-
W<_c
cvw
u<UlZ \jw Aa /^JL /
CTIa Q
^py\j"e.A_^cdr -^<7\_A- Cl Va -
jV-ruV L?
—~
i) What are the cost implications?
tvv\_
—
- r
"n
_
-
(Gl ^KeUL^
Ccvt
— 0 Co<K^CV'^jJ<Xc-.
— Prv'vcJLx^
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
Aaa ^U.
be.taken
b) H^wcan4l^se issues
KeikepSC^
/
V
KJ I A
^-L£<^d a.
vv^w/dut)
u
a u -'Wl
‘ ) -fc_K.Oo c CG2rV\Z'V<\AA>vJ2-, -tAy< ^VU2
/ Ca AA-£—
cx WW c
.- £ c ^jlaj Ja Qc 'c
c) With whom should they be taken up?
—
C^3--vA^Z<p-
C> ^z0'
Contact addresses:
:> Eric Ram, Chairman, c/o World Virion International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
1 el. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
! ■ Alireza Mahallati, Freasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372. CH-1211 Geneva 19 Switzerland
*' cl. (41-22) 730 44 88
F ax (4 I 22) 733 03 95
E-mail: mahallat@iFrc.org
■d- Giovanni Ballerio, Secretary, c/o Baha'i Intcriniional Community, 15 rte. des Morillons, CH-12'18 Grand-Sacconex,
Switzerland
Id. (4 1-22) 798 54 00
I
(4 I 22) 798 05 77
E-mail: gballerlo@gorieva.bic.org
NGO FORUM FOR HEALTH
----- partnering to make lieaftli a reality
----- promoting equity and juitice in heaftk care -
d ) What is the likely impact of such initiati ves?
IX\U
'IWha -
'I.
\A^_^X.C C
gxxa
Xa JL
CWk Jal
iu v \
_X_
Vu \^ajuaa _Uo
ck_L .
e) Is there a need formaltema
alternate reporting system whereby NGOs can provide shadow reports to
oilicml uoveimnent reports (as in the Convention on the Rights of the Child for example)
l-VOAJJL X CA
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
KJ G o
A
WUU
Lk.4
b) What different roles could they play?
MQo
Wbvd
Ua
cva ^
OWLcV
(kic/'vyviZ'
5. ORGANISATION
a) How would a national wafch be organised?
JEca ^>
<X/kxL< KjV-tLv<_eJ^> x
P'VVv A^Gl LU^
iGty
Oaa JL
.
'th
I-
<xa Lv G,
IOul |
'Vv^duiH^
k lAAJULtk^o
Contact addresses:
M'lC™^^Or,d ViSiOn lnTad0 la Tourelle' CH-1209 Geneva' Switzerland
a-. »ra M.n...B,
... (
^aa /W<
Sm_^AX
« cSs tasssaaM.
d0 n.
P-O-Box 37.<. g H'I211 Geneva 19 Switzerland
S,S^Xry. c/0 Baha-l
15 de. deSo^&d.sacconex
, ZJJ
lei. (41-22) 798 54 00
Switzerland
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.biC.org
NGO FORUM FOR HEALTH
fl h
partnering to maLe he a
a reci
ci
re ci fity __
- promoting e^utl^ and fultlce in keaftli care -
in health
e(i
b) What should be the structure?
c) How should it relate to a global health watch?
d) How should the capacity of national and local NGOs
strengthened?
—
‘l'' S0"‘h b=
V o Ja _aj 2_
^7
e) Mow can a wide, sustainable and independent funding base be maintained?
w
)
V
C\ Cr-uV
VTrCtji ’A^Aak -Jj ^ •
G OC
Ct CAAU
CCcd-^JL
have been related to a National Watch, watchini>
6. All the above questions
.
nationally Ho you have any .suggestions of how a National Watch watching
can also
also
' a National Watch can
feedback <OIV' Ou’a>.reC°,K!n?' Is:a'us’ processes and projects that affect National
Policies ie., South -North dialogue - to whom and how?
IMXJU CXL
NilC-NtT C©xj GLA_
7. AI)OITIoiv& PCUNTS^
Have you got any other points you would like to raise either from a global or national
perspective regarding the creation of a Global Health Watch?
<j^'VVA^adLLuj CK
<Tiz ^
Ui
-
WT C,
AAA.
Cl
Uf Ca Ltj AL
RETURN TO:
Dr. Ravi Narayan,
Community Health Cell,
Society for Community Health Awareness, Research and Action
B^iore''sS 034 ilaya' JakkaSandra 1 Ma'n> 1 BIock- Ko^mangala,
Phone , (080) 553 15 18 & 552 53 72
Fax ■ (080) 552 53 72 Email : sochara@vsnl.com
Ca Maa H* A '
NGO FORUM FOR HEALTH
to make Leafth a readily. -----and justice in he a (th care —
promoting eg ally
----- partnering,
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
• Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
• It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
• Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
Organisation:
Address:
3^9
Telephone number:
Fax number:
E-mail
’
Azl
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio. Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
E-mail: gballerio@geneva.bic.org
Fax (41-22) 798 65 77
Tel. (41-22) 798 54 00
c
NGO FORUM FOR HEALTH
----- partnering, to make lieaftk a reaPltg -----
----- promoting eguitg and fuitice in lieafth care —
I. WHAT ARE THE INEQUALITIES IN HEALTH IN YOUR COUNTRY
a) What are the inequalities and inequities in health in your country?
Consider, for example:
- are certain groups particularly disadvantaged in terms of health provision based on class, caste,
gender,
race, ethnicity, sexual orientation.
- are there socio-economic and geographical differences in health indicators such as mortality,
morbidity rates etc.
- are there socio-economic and geographical differences in access to health care
- are there socio-economic and geographical differences in the resources spent on health care
«
J,
£-
in’ caS1
cH
S'
JI
—J
‘
’tH \
7^5.
5-
b) Implementation of treaties, conventions, plans of action etc.
Is the Government fulfilling commitments made in international agreements such as WHO Health
For All strategy or the health provisions of the various international conferences of the 1990s such
as Rio, Copenhagen, Cairo, Beijing etc.
k
.A ■’A
CiAi.
S'
0)f
(JI
iV
Jk. ^
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@ip’rolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
------ partne rincj. to ma he Leafth a re a fit y ------
------ promoting, eguitg and juitice in keaftk care —
c) Are there any specific examples where these inequalities are being compounded by other factors
such as the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
a
0U
2. HOW WOULD YOU MEASURE THESE INEQUALITIES
a) How would you show that these inequalities exist?
r
<2—
L<a-zn’ S.
? -
.‘5
b) Which sources of data and information in your country can be used for monitoring?
4_
’x
(•-S'
fc" A
.
c) What about the accuracy and transparency of Government data?
y <gsuv JU-U c,
2<
GJ.
, J
d) Is there a need for a primary collection of data or would it be possible to analyse existing data?
e) How is it possible to gain access to this data?
*
^1- Le
Pa
- ZK\
L,
fe;
4t<M^ ^^^3.
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
------ partnering to
promoting, egaitg
maLe he a (th a reafitg ------
and /.uitice in lieaHtli care —
f) How will it be possible to verify if the data is reliable and accurate?
ve-^Jp
2.
g) Is there a need to protect sources and is so how?
h) Who would monitor the data and how?
— “■fa*
i) What are the cost implications?
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
c
'5
i
GA
H-c
<y< 'VTS^yvitL-k'cT*/
^V<«
< z*y
b) How can these issues be taken up?
fyJkc ■
-4j'TuV-)es»<
4v^au-Av4< 6
c) With whom should they be taken up?
Qj f
.
£x^-Z'OA‘.
Qji
<2-*-^
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
E-mail: wvi.gva@iprolink.ch
Fax (41-22) 798 65 47
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
E-mail: mahallat@ifrc.org
Fax (41-22) 733 03 95
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
(9
NGO FORUM FOR HEALTH
---- P artnerin. 9 to
promo ting. equ.Lt^
make health a rea
a rea
and justice in heaftk
he aft h care —
d) What is the likely impact of such initiatives?
o
SUe><e^S<2^-8,{
d«s3VVlV*^—•
e) Is there a need for a alternate reporting system whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
chA^
CO CKJ
I H <^3 c>re-dd?^ c
ic4<sAaJ .
*^A.
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
v
<2^Ji
C-\
Jv*Av^lTMJ2-bdr
he j <3Ti3^ctfr
b) What different roles could they play?
4
5. ORGANi:
ION
a) How would a national watch be organised?
6^
G.
r
CVv*Xj vX.A.uo5-'!-^
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
-- partnering, to make lieattli a reality. ----promoting eguitg and fuit ice in lie aft !i care —
b) What should be the structure?
-S’1
c) How should it relate to a global health watch?
^UiA.
-•^n
<0
d) How should the ^pachy
national
e) Tv «cl .
(T <TQ}V7
dryl
and local NGOs from the South be strengthened?
Ca /O
1
e) How can a wide, sustainable and independent funding base be maintained?
x-p/
,
■o
•
X)// /Z-C
-c r
bec^>
(^rA
|
<=
'■
■'•!<■!'■'
t. "> he\C
Sugcrl! "
- O yc'- hr-,c
rte'/-Xl
'Ccr, hc<r^
>•<5^ ft ' K/crv II
I' c/cri MJrvxrl ZX'Trci e.
to
c
C- <ryv tc
I •» c ) v C'-> ■) r ’
-»;• '.s
aj^p
>J -I
'V. ADDITIONAL POINTS
Have you got any other points you would like to raise either from a global or national perspective
regarding the creation of a Global Health Watch?
RETURN TO: Div-Eric Ram at the address below
9> /?r^,
O' C
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
r» at Tel‘ JI^’22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel- (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
----- partnering, to
promoting, equity.
maLe lieaftli a rea/tily. -----a re a
and j. nil Ice in Leafth care —
in Leaf th
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
• Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
• It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
• Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
Organisation:
/5
Address:
Telephone number:
/Z
Fax number:
E-mail
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22)798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
----- partnering, to maLe he alt k a re a —
----- promoting eguitg and j. uit ice in ke all k care
I. WHAT ARE THE INEQUALITIES IN HEALTH IN YOUR COUNTRY
a) What are the inequalities and inequities in health in your count:
Consider, for example:
- are certain groups particularly disadvantaged in terms of health provision based pn
gender,
race, ethnicity, sexual orientation.
- are there socio-economic and geographical differences in health indicators such as mortality,
morbidity rates etc.
f
- are there socio-economic and geographical differences in access to health care
- are there socio-economic and geographical differences in the resources spent on health care
^■UxL
b) Implementation of treaties, conventions, plans of action etc.
Is the Government fulfilling commitments made in international agreements such as WHO Health
For All strategy or the health provisions of the various international conferences of the 1990s such
Cairo, Beiiine
Beijing etc.
as Rio, Copenhagen, Cairo.
IL
Contact addresses:
/
(j
I*
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Genevan-Switzerland
n
Tel-(41‘22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies, U '■
P.0. Box 372, CH-1211 Geneva 19 Switzerland
/
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
f
Mr. Giovanni Balleno, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
'
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org A
zs /
NGO FORUM FOR HEALTH
----- partnering, to
promoting, eguitg
make lie aft It a re a fit g ------
and ynotice in lieaftk care —
c) Are there any specific examples where these inequalities are being compounded by other factors
such as the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
2. HOW WOULD YOU MEASURE T
SE INEQUALITI
a) How would you show that these inequalities exist?
>4
b) Which sources of data and information in your country can be used for monitoring?
ctCy
c) What about the accuracy and transparency of Government data?
d) Is t
ata or would it be possible to analyse existing data?
U4
J2^/S
e) How is it possible to gain access to this data?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
u
NGO FORUM FOR HEALTH
----- partnering, to
promoting eguitg
ft t ---
maLe lie aft li a re a
and justice in he a ft li care —
f) How will it be possible to verify if the data is reliable and accurate?
g) Is there a need to protect sources and i^so how?
h) Who would monitor the data and how?
i) What are the cost implications?
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
b) How can these issues be taken up?
c) With whom should they be taken up?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
8
NGO FORUM FOR HEALTH
partnering, to
pro moling eguitg
make lie a ft k a re a fit g -----a re a
and justice in lieaftli
lieaftli care —
d) What is the likely impact of such initiatives?
e) Is there a need for a alternate reporting system whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
b) What different roles could they play?
5. ORGANISATION
a) How would a national watch be organised?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
pt —
------ partnering, to male lie a ft li a rea
rea
------ promoting eguitg and justice in lie
lie aft
aft lili care —
b) What should be the structure?
(9
c) How should it relate to a global health watch?
d) How should the capacity of national and local NGOs from the South be strengthened?
e) How can a wide, sustainable and independent funding base be maintained?
f
/
'O
n// de
cSr-.rl
c?
C.
/
/» - r r-,
r-' yr r
tc
fr. C
“>
. O-
h
c' -x
ijc c l-i
/
J
b
0^9-)
t’c rf
c
i
Ir I
r<
•
•
r / ><■ I
-e.
ADDITIONAL POINTS
Have you got any other points you would like to raise either from a global or national perspective
regarding the creation of a Global Health Watch?
RETURN TO: Div-Eric Ram at the address below
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
n at Tel’ KV2??
41 83
Fax f41"22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Ahreza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
789 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
----- partnering, to
promoting, equity
maLe Leafth a reafity. -----a re a
and fiiAtice in
in keaftli
Leaftli care —
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
• Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
• It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
• Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
Organisation:
Address:
Telephone number:
Fax number:
E-mail
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati. Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio. Secretary, c/o Baha'i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
CL
NGO FORUM FOR HEALTH
------ partnering, to maLe health a readitg ------
------ promoting eguitg and fustice in lieaftk care —
I. WHAT ARE THE INEQUALITIES IN HEALTH IN YOUR COUNTRY
a) What are the inequalities and inequities in health in your country?
Consider, for example:
- are certain groups particularly disadvantaged in terms of health provision based on class, caste,
gender,
race, ethnicity, sexual orientation.
- are there socio-economic and geographical differences in health indicators such as mortality,
morbidity rates etc.
- are there socio-economic and geographical differences in access to health care
- are there socio-economic and geographical differences in the resources spent on health care
/
he
b) Implementation of treaties, conventions, plans of action etc.
Is the Government fulfilling commitments made in international agreements such as WHO Health
For All strategy or the health provisions of the various international conferences of the 1990s such
as Rio, Copenhagen, Cairo, Beijing etc.
rv
r
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Fax (41-22) 798 65 77
Tel. (41-22) 798 54 00
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
— p art ne ring, to
promo ting
make lieaftli a rea
a rea
—
fill care —
eguiit^ and justice in lie a (tli
c) Are there any specific examples where these inequalities are being compounded by other factors
such as the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
, 4t<rv«*»o
2. HOW WOULD YOU MEASURE THESE INEQUALITIES
a) How would you show that these inequalities exist?
b) Which sources of data and information in your country can be used for monitoring?
6L*~c/(
^0
c) What about the accuracy and transparency of Government data?
4^1
to
M
13VJ^
/
I
d) Is there a need for a primary collection of data or would it be possible to analyse existing data?
(a , ^ds T'
e) How is it possible to gain access to this data?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
E-mail: gballerio@geneva.bic.org
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
□
NGO FORUM FOR HEALTH
—
------ partnering to ma ho lieaftli a re a
------ promoting, eguitg and j. a 5 t ice in Leaf th care —
f) How will it be possible to verify if the data is reliable and accurate?
g) Is there a need to protect sources and i^so how?
h) Who would monitor the data and how?
i) What are the cost implications?
a
^9V
' /6zVvZ
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
b) How can these issues be taken up?
c) With whom should they be taken up?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
--- partnering, to make keaftk a reality. -----a re a
- promoting equity and lattice in keaftk care —
an
he aft k
d) What is the likely impact of such initiatives?
e) Is there a need for a alternate reporting system whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
b) What different roles could they play?
5. ORGANISATION
a) How would a national watch be organised?
$
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Fax (41-22) 733 03 95
Tel. (41-22) 730 44 88
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
C
NGO FORUM FOR HEALTH
make health a re a di t
to ma
--in
care
tinq.
and
keadth
equity
—
justice
------- promo
----- P artnering.
V eci
b) What should be the structure?
c) How should it relate to a global health watch?
d) How should the capacity of national and local NGOs from the South be
strengthen^
.
n-vYt,
ho
C^'
e) How can a wide, sustainable and independent funding base be maintained?
p
'-h'C,
v/lc
6. All the above questions have been related to a National Watch, watching
nationally. Do you have any suggestions of how a National Watch can also
feedback on global economy, issues, processes and projects that affect National
Policies ie., South-North dialogue - to whom and how?
Xrv'Uz-'C
7. ADDITIONAL POINTS
^5
crx, ■
Have you got any other points you would like to raise either from a global or national
perspective regarding the creation of a Global Health Watch?
RETURN TO:
Dr. Ravi Narayan,
Community Health Cell,
Society for Community Health Awareness, Research and Action
No.367, 'Srinivasa Nilaya' Jakkasandra I Main, I Block, Koramangala,
Bangalore - 560 034.
Phone : (080) 553 15 18 & 552 53 72
Fax : (080) 552 53 72 Email : sochara@vsnl.com
!
I '
NGO FORUM FOR HEALTH
«
—
------ partnering to maLe Ae a ft k a re a
----- promoting equity, and justice in keaftk care —
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
• Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
• It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
• Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
Organisation:
A \iYV\W\
Address:
Telephone number:
Fax number:
E-mail
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
E-mail: gballerio@geneva.bic.org
Fax (41-22) 798 65 77
Tel. (41-22) 798 54 00
&
NGO FORUM FOR HEALTH
----- partnering, to make he a (th a re a fit y. --------- promoting eguitg and justice in heafth care —
" I. WHAT ARE THE INEQUALITIES IN HEALTH IN YOUR COUNTRY
a) What are the inequalities and inequities in health in your country?
Consider, for example:
- are certain groups particularly disadvantaged in terms of health provision based on class, caste,
gender,
race, ethnicity, sexual orientation.
- are there socio-economic and geographical differences in health indicators such as mortality,
morbidity rates etc.
- are there socio-economic and geographical differences in access to health care —
- are there socio-economic and geographical differences in the resources spent on health care
b) Implementation of treaties, conventions, plans of action etc.
Is the Government fulfilling commitments made in international agreements such as WHO Health
For All strategy or the health provisions of the various international conferences of the 1990s such
as Rio, Copenhagen, Cairo, Beijing etc.
'CL
Ws
to. Xcy
eV'- CrAzCjJ xYTorfK
v’
Cs?(\ <« v4
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
E-mail: gballerio@geneva.bic.org
Fax (41-22) 798 65 77
Tel. (41-22) 798 54 00
NGO FORUM FOR HEALTH
k
------ partnering to ma ea(th a rea—
----- promoting, equity, and justice in keaftk care ----c) Are there any specific examples where these inequalities are being compounded by other factors
such as the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
2. HOW WOULD YOU MEASURE THESE INEQUALITIES
a) How would you show that these inequalities exist?
Olqcc '—-'<W
b'-
far
IhuUR
b) Which sources of data and information m
in your country can be used for monitoring?
A<- 'Yx'h <-i p vl VsmCnK 1
c) What about the accuracy and transparency of Government data?
7Tks
d) Is there a need for a primary collection of data or would it bepossible to analyse existing data?
e) How is it possible to gain access to this data?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
Tel. (41-22) 798 54 00
NGO FORUM FOR HEALTH
------ partnering to maLe Aeaith a re ahtlf —
----- promoting equity and justice in keaftk care —
f) How will it be possible to verify if the data is reliable and accurate?
g) Is there a need to protect sources and is so how?
h) Who would monitor the data and how?
i) What are the cost implications?
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
b) How can these issues be taken up? ‘ \
vT
c) With whom should they be taken up?
H yj ?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
1 _
NGO FORUM FOR HEALTH
ke k
ealtk aa re a—
eaftk
------ partnering to ma
ma
----- promoting, equity, and justice
juitice in keaHtli care —
d) What is the likely impact of such initiatives?
1
’
Z^,
e) Is there a need for a alternate reporting system whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
b) What different roles could they play?
T3
'nfr'Y'f4'
5. ORGANISATION
a) How would a national watch be organised?
J
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
E-mail: gballerio@geneva.bic.org
Fax (41-22) 798 65 77
Tel. (41-22) 798 54 00
NGO FORUM FOR HEALTH
-- - partnering to make health a reality
- promoting, equity and juitice in lieaJtk care —
b) What should be the structure?
Wh
c) How should it relate to> a global health watch?^/
d) How should the capacity of national and local NGOs from the South be
strengthened?
e) How can a wide, sustainable and independent funding base be maintained?
6. All the above questions have been related to a National Watch, watching
nationally. Do you have any suggestions of how a National Watch can also
feedback on global economy, issues, processes and projects that affect National
Policies ie., South-North dialogue - to whom and how?
7. ADDITIONAL POINTS
Have you got any other points you would like to raise either from a global or national
perspective regarding the creation of a Global Health Watch?
RETURN TO:
Dr. Ravi Narayan,
Community Health Cell,
Society for Community Health Awareness, Research and Action
No.367, 'Srinivasa Nilaya' Jakkasandra I Main, I Block, Koramangala,
Bangalore - 560 034.
Phone : (080) 553 15 18 & 552 53 72
Fax : (080) 552 53 72 Email: sochara@vsnl.com
NGO FORUM FOR HEALTH
--------partnering
to make lieafth a reafity. ------
------ promoting, equity and fuitice in lieaftli care —
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
• Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
• It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
• Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
Organisation:
Address:
f 3>
Telephone number:
i i
Fax number:
E-mail
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o i he International Federation of the Red Cross and Red Crescent Societies,
P.O. Bex 372, CH-1211 Geneva 19 Switzerland
^e!730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Bailerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: aballerio(®aeneva.bic.om
NGO FORUM FOR HEALTH
readily. ----a rea
----- partnering to maLe he aft k a
keaftk care —
----- promoting, equity and iuitice in keaftk
I. WHAT ARE THE INEQUALITIES IN HEALTH IN YOUR COUNTRY
a) What are the inequalities and inequities in health in your country?
Consider, for example:
- are certain groups particularly disadvantaged in terms of health provision based on class, caste,
gender,
race, ethnicity, sexual orientation.
- are there socio-economic and geographical differences in health indicators such as mortality,
morbidity rates etc.
- are there socio-economic and geographical differences in access to health care
- are there socio-economic and geographical differences in the resources spent on health care
C
d? cd fay y>i'/
b) Implementation of treaties, conventions, plans of action etc.
Is the Government fulfilling commitments made in international agreements such as WHO Health
For All strategy or the health provisions of the various international conferences of the 1990s such
as Rio, Copenhagen, Cairo, Beijing etc.
1^0!
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha'i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
NGO FORUM FOR HEALTH
------ partnering, to maLe heaftli a re a------
------ promoting e g ait g and justice in Leaf th care -----
c) Are there any specific examples where these inequalities are being compounded by other factors
such as the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
G
TRIPS'
2. HOW WOULD YOU MEASURE THESE INEQUALITIES
a) How would you show that these inequalities exist?
7^7
/Zd y^lc
b) Which sources of data and information in your country can be used for monitoring?
(Ax
Jyjff ia J
aw Co
c) What about the accuracy and transparency of Government data?
d) Is there a need for a primary collection of data or would it be possible to analyse existing data?
e) How is it possible to gain access to this data?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
NGO FORUM FOR HEALTH
----- partner in $ to make lie aft k a reaflty --------- promoting
Uy and j-uitice in keaftk care —
f) How will it be possible to verify if the data is reliable and accurate?
g) Is there a need to protect sources and is so how?
h) Who would monitor the data and how?
i) What are the cost implications?
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
(m. kJ.
(2^)
)
b) How can these issues be taken up?
c) With whom should they be taken up?
L/cd't
•
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Fax (41-22) 798 65 47
Tel. (41-22) 798 41.83
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
.P.O. Box 372, CH-1211 Geneva 19 Switzerland
Fax (41-22) 733 03 95
Tel. (41-22) 730 44 88
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha'i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Ta I
798 54 00
E-mail: aballerioOaeneva.bic.orq
Fax (41-22) 798 65 77
NGO FORUM FOR HEALTH
----- partnering to maLe lieaftk a rea ft t ------- promoting, eguitg and justice in keaftk care —
d) What is the likely impact of such initiatives?
e) Is there a need for a alternate reporting system whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
r\
A
.
A
I
J\
A
0
/
(T^ )7C^ -
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
O O
■ 'X
LV^iy^T- ’
^/L'l/^Ce^>
b) What different roles could they play?
y.-' b
O 0
- Z^/>cl4-X^
5. ORGANISATION
o
e>
X-
f
a) How would a national watch be organised?
3^ (2^ ’n-cn -1
W/lauti
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
F-maib nhallpriniTiJapnova hir* nrn
NGO FORUM FOR HEALTH
------- partnering to make lieadtk a reality. -----
to
------promoting ec^u.iti^ and j. ait ice in lieadtli care —
e^uit^.
b) What should be the structure?^
■I
/JI
U
tJ •
1
1
it relate
health watch?
c)X IT
How should
to a global
/
</
(/
d) How should the capacity of national and local NGOs from the South be
strengthened?
,
/ ,
n
e) How can a wide, sustainable and independent funding base be maintained?
11
6. All the above questions have been related to a National Watch, watching
nationally. Do you have any suggestions of how a National Watch can also
feedback on global economy, issues, processes and projects that affect National
Policies ie., South-North dialogue - to whom and how?
Co (Cntrktid
7. ADDITIONAL POINTS
Have you got any other points you would like to raise either from a global or national
perspective regarding the creation of a Global Health Watch?
by
RETURN TO:
Dr. Ravi Narayan,
Community Health Cell,
Society for Community Health Awareness, Research and Action
No.367, 'Srinivasa Nilaya' Jakkasandra I Main, I Block, Koramangala,
Bangalore - 560 034.
Phone : (080) 553 15 18 & 552 53 72
c
WTO. Trading for the future. World Trade Organisation, Geneva. 1995
WTO. United States - standards for reformulated and conventional gasoline. Dispute settlement
body. Apellate body report and panel report. WTO, Geneva. 1996a.
WTO. Japan - taxes on alcoholic beverages. Dispute settlement body. Apellate body report and
Panel report. WTO, Geneva. 1996b.
WTO. EC measures concerning meat and meat products (hormones) complaint by the United States.
Dispute settlement. Panel Report. WTO, Geneva. 1997a.
WTO. Introduction to the WTO. Trading into the future. WTO, Geneva. 1998a.
WTO. EC Measures concerning meat and meat products (hormones). WT/DS26/AB/R. Report of
the Appellate Body, 16 January 1998. WTO, Geneva. 1998b.
WTO. EC Measures concerning meat and meat products (hormones). WT/DS26/15, WT/DS48/13.
Arbitration under Article 21.3.(c) of the Understanding on Rules and Procedures Governing the
Settlement of Disputes. World Trade Organisation, Geneva. 1998c.
WTO. European Communities - Measures Affecting the Prohibition of Asbestos and Asbestos
Products, complaint by Canada. WT/DS135. World Trade Organisation, Geneva. 1998d.
WTO. Council for Trade in Services.Health and Social Services. S/C/W/50. 18 September 1998.
WTO, Geneva. 1998e
WTO. Overview of the Agreement on Government Procurement. In world wide web URL:
http://www.wto.org/wto/govt/over.htm. WTO, Geneva. Printed May 4, 1999,
FROM I IM BANGAORE.
6644050
J [M B
10-06 16:36 ’99
PAGE : 0 1
IF®,
560 076 Mrtd
Indian Institute of Management Bangalore
Biinnr.rghaiki Road. Bangalore - 5f>0 076 India
Fax No.: 552 5372
Attn: Dr. Ravi Narayan,
Sub.: Global Health Watch Questionnaire
From: Prof. Gita Sen
^TTnri’hone 6632450
Telex 0845-2472 rOT (_al?!e MANAGEMENT TO l-ax 0fi0-6614050
System, the Directorate General of Health Services and the International Institute for
Population Sciences (NHFS). National level statistics allow us an overview of state
variations, urban-ruml distnbutioris and, to some extent, differences between economic
categories and across gender, But die full extent of inequalities can be appreciated only
through micro studies which actively seek to record - and miderstand - them.
c) Wlial about the accuracy and tr ans[.>arency of (Government data?
Government data is not always accurate nor are the processes - and limitations - of data
collection transparent. But it is something that we have to work with
d) Is there a need for a primary collection of data or would it be possible to analyse
existing data 7
An iltemate national data set would be great but would it be possible 7 Also where is the
money for such an exercise to be found? In such a case, it might be useful to do smaller
studies that can validate die findings of larger studies on a few indicators.
e) How is it possible to ^am access to this data7
Government data is available in all major libraries Smaller studies - especially those done by
NGOs - are more difficult to access since they are poorly distributed.
f) How will 11 be possible to verify if the data is reliable and accurate ?
By comparing the findings of smaller studies (with sound methodologies) with relevant
sections of tlie national data 9 Or by working out independent and theoretically sound
estimates 7
/>' there a need to protect sources and if so how 7
h) Who would monitor the data and how 7
i) What are the cost implications?
3.
Advocacy
Questions (a) to (e) should be discussed in the meeting
4.
Partners
Questions (a) and (b) should be discussed in the meeting
5.
Organisation
Questions (a) to (e) should be discussed in the meeting]
:
Suggestions of how a National Watch can also feedback on global
economy issues and projects that affect National Policies, i.e, South-North
dialogue • to whom and how? &
7, '
Additional Points
I
[Should be discussed in the meeting]
FROM I IM BRHGRORE.
6644950
10-06
16:39 ’99
Global Health Watch Questionnaire
1.
What are the inequalities in health in your country?
a) mat are the inequalities and inequities m health in you?- country ?
Inequalities are apparent in almost all facets of health and nutritional status, as well as health
outcomes and health care. There are gross variations m mortality, morbidity; life expectancy
and health care utilization across regions, urban & rural divides, caste and class. Caste, class
and history interface with gender in crucial and complex ways. So tlie intricacies and the
manner in which inequalities are lived out are better understood th rough a gender analysis of
health and health care.
b) Implementation of treaties, conventions, plans ofaction, etc. Is the government
fulfilling commitments made in international agreements such as WHO Health For
AU strategy or the health provisions of the various conferences of the 1990s such as
Rio, Copenhagen, ('airo, Beijing, etc.
In the case of the ICPD, the Indian government’s commitment to promote reproductive health
has led to a flurry of activity on the part of multilateral funders who have been working with
the government on die shift from the erstwhile Family Welfare Programme to a Reproductive
and Child Health Approach. Such a shift has occurred but the pace and process of change has
inevitably been slow and somewhat checkered. Above all, there is a paucity of knowledge
about what the ICPD has meant in terms of population policies and women’s health. As far as
1 know, there is little documented evidence of women demanding a fuller range of
reproductive health care services
A problem that is bound to limit tlie efforts of even those governments that arc serious about
implementing the sentiments of international agreements stems from the disparate character
of the health care services. India does not have a health care system: there is an absence of
holistic planning involving the public and private sectors, there i$ no unifying framework of
regulation & financing and a non-existent referral system. Implementation of the POAs of
international agreements is mainly m the public health services which is not the dominant
sector in health care.
e) Specific examples m here these inequalities are being compounded by otherfactors
such as activities ofprivate sector organisations, corruption and inefficiency in health
managemeni, etc.
2.
How would you measure these inequalities
a) Hov-' would you show that these inequalities exist?
Disaggregated data, comparative perspectives and narratives of those who are in a position to
access so little
b) Wliich sources of data and information in your country can be used for
monitoring?
We have to build a foundation on whatever exists by way of national data sets like Census
figures as well as data of the National Sample Survey Organisation, the Sample Registration
PRGE : 0 1
F
NGO FORUM FOR HEALTH
------ partnering, to make lieaftli a re a (ity. --------- promoting eguitg and j. notice in keaftli care —
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
• Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
• It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
• Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
Organisation:
Address:
A N u £ A 61
*JA iN
^0 •
Sw Asthy A
L
SA Hy<06
f)ev na r)da n
Telephone number:
C1 I - z?-7 7/l - 4- 0
7S'
Fax number:
E-mail
Corn
Contact addresses:^
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
E-mail: gballerio@geneva.bic.org
Fax (41-22) 798 65 77
Tel. (41-22) 798 54 00
0
NGO FORUM FOR HEALTH
--- partnering to make keaftli a reafity. ----promoting, equity and justice in he a ft h care —
I. WHAT ARE THE INEQUALITIES IN HEALTH IN YOUR COUNTRY
a) What are the inequalities and inequities in health in your country?
Consider, for example:
- are certain groups particularly disadvantaged in terms of health provision based on class, caste,
gender,
race, ethnicity, sexual orientation.
- are there socio-economic and geographical differences in health indicators such as mortality,
morbidity rates etc.
- are there socio-economic and geographical differences in access to health care
- are there socio-economic and geographical differences in the resources spent on health care
b) Implementation of treaties, conventions, plans of action etc.
Is the Government fulfilling commitments made in international agreements such as WHO Health
For All strategy or the health provisions of the various international conferences of the 1990s such
as Rio, Copenhagen, Cairo, Beijing etc.
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
make kealtk a realitg -----a rea
and
fudtice
in
kealtk care —
promoting eguitg
----- partnering, to
he alt k
c) Are there any specific examples where these inequalities are being compounded by other factors
such as the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
2. HOW WOULD YOU MEASURE THESE INEQUALITIES
a) How would you show that these inequalities exist?
b) Which sources of data and information in your country can be used for monitoring?
c) What about the accuracy and transparency of Government data?
d) Is there a need for a primary collection of data or would it be possible to analyse existing data?
e) How is it possible to gain access to this data?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
E-mail: wvi.gva@iprolink.ch
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
E-mail: gballerio@geneva.bic.org
Fax (41-22) 798 65 77
a
NGO FORUM FOR HEALTH
to maLe health a re a fit -----and j. ait ice in Leafth care —
— p romoti ng e q a <Uy
— partnering,
f) How will it be possible to verify if the data is reliable and accurate?
g) Is there a need to protect sources and is so how?
h) Who would monitor the data and how?
i) What are the cost implications?
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
b) How can these issues be taken up?
c) With whom should they be taken up?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
------ partnering to
------ promoting, eguitg
make Leafth a re a fit
------
and justice in heaftli care —
d) What is the likely impact of such initiatives?
e) Is there a need for a alternate reporting system whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
b) What different roles could they play?
5. ORGANISATION
a) How would a national watch be organised?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
E-mail: gballerio@geneva.bic.org
Fax (41-22) 798 65 77
C
NGO FORUMJOR HEALTH
------ partneri ny
------ promotin 9
readily. -----to make Leafth aa rea
and fustice in lie
lieaftli
a dt!i care —
a
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
• Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
• It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
• Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
Organisation:
■
Address:
Telephone number:
Fax number:
E-mail
^2 Cc k
i
o
(I
y.-r'. v-SinU
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
E-mail: mahallat@ifrc.org
Fax (41-22) 733 03 95
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
E-mail: gballerio@geneva.bic.org
Tel. (41-22)798 54 00
Fax (41-22) 798 65 77
NGO FORUM FOR HEALTH
------
partnering, to male'
k.M a re a lit g -------
----- promoting egaitg and justice in
lie a ft It care —
in health
I. WHAT ARE THE INEQUALITIES IN HEALTH IN YOUR COUNTRY
a) What are the inequalities and inequities in health in your country?
Consider, for example:
- are certain groups particularly disadvantaged in terms of health provision based on class, caste,
gender,
race, ethnicity, sexual orientation.
- are there socio-economic and geographical differences in health indicators such as mortality,
morbidity rates etc.
- are there socio-economic and geographical differences in access to health care
- are there socio-economic and geographical differences in the resources spent on health care
■V-L(LAj 8.
TG
tcJs1 .
GGl
oA-diiAjGj Q
Cr2yu, f
b) Implementation of treaties, conventions, plans of action etc.
Is the Government fulfilling commitments made in international agreements such as WHO Health
For All strategy or the health provisions of the various international conferences of the 1990s such
as Rio, Copenhagen, Cairo, Beijing etc.
C'Vi
Contact addresses:
Dr. Eric Ranr, Chairman, crb World
Worl Vision International, 6 Chemin de la Toulelle,
Geneva, Iwitzerland
Tourelle, CH-1209
CHTel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and RedX res cent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
P
I
C -> flTj
Tel .(41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Balleno, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex.^j^M^v)
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
------ partnering to make keaHtk a reafity. -----a re a
------ promoting, equity and fuitice
care -----in inliekeaftk
a Hlk
c) Are there any specific examples where these inequalities are being compounded by other factors
such as the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
J
— ' £ c/vvx-
X g
2. HOW WOULD YOU MEASURE THESE INEQUALITIES
a) How would you show that these inequalities exist?
-TTX-V1
^5
I
'
•s
b) Which sources of data and information in your country can be used for monitoring?
c) What about the accuracy and transparency of Government data?
VC-A-AO.
VCX A
d) Is there a need for a primary collection of data or would it be possible to analyse existing data?
e) How is it possible to gain access to this data?
(SitrsT^
— Ao
2^
I
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
E-mail: gballerio@geneva.bic.org
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
V
NGO FORUM FOR HEALTH
ma he lie ci (til a
—
a
a re
re a
a (th
he a
(th care —
promoting, eg ait g and fast ice in lie
----- partnering, to
f) How will it be possible to verify if the data is reliable and accurate?
i'
g) Is there a need to protect sources and i^so how?
J -€_^O —
Un
err
h) Who would monitor the data and how?
? NClO
i) What are the cost implications?
i liyri
j
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
b) How can these issues be taken up?
v.
K
J
---
c) With whom should they be taken up?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
------ partnering to
------ promoting
ting. eguitg
maLe keaftk a re a fit g ------
and j.u.Atice in keaftk care —
d) What is the likely impact of such initiatives?
C
e) Is there a need for a alternate reporting system whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
i
MG Os.
b) What different roles could they play?
***—
15
Mie
5. ORGANISATION
s
a) How would a national watch be organised?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
—
a re
re cla
- promoting, equity, and justice in keaftk
he a ft k care —
to nr a L e ke a.
-------partnering
k
cl
b) What should be the structure?
c) How should it relate to a global health watch?^^
d) How should the capacity of national and local NGOs from the SouthstrengtheiSd?
"y BL e) How can a wide, sustainable and independent funding base be maintained?
On it
o>
y c' ‘
.. O
’• ...
>
/ r r a t^c. C '''
, '
rl px- ■- j
<’’ <•
f
/'
<- I
e V
C'; ■
‘
X: '
C
j ( S’
c
■: <**(
ADDITIONAL POINTS
Have you got any other points you would like to raise either from a global or national perspective
regarding the creation of a Global Health Watch?
j),
RETURN TO: Drv-Eric Ram at the address beloW
9; i-9... • v - r
h
c
e
I
i /
______________________ k
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
International Centre
For Health Sciences
2
■*
(Manipal Hospital Unit)
Or. Pankaj Mehta
MBBS., M.D.
ASSOCIATE DEAN
PROFESSOR, HOD
COMMUNITY MEDICINE
h/h
'^f h
98, Rustem Bagh, Airport Road, Bangalore 560 017.
2 : 5266646, 5266441,5266757 Ext. 270 Fax : 5266757
■ 14
NGO FORUM FOR HEALTH
A
------ partnering, to ma
e a ft h a reafitg
------ promoting eguitg and fudtice in keaftkcclre —
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
♦ Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
9
It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
>
Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
UN! L
Organisation:
A
Address:
k/
/vy/} WN
Telephone number:
I
l
(^>0 T2-53 ZbO
Fax number:
E-mail
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
n
Tel-(41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@jfrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
IN VI
ruKun HUK HEALTH
to make keatlli a reatity
— p arttnerin^
------- promo tin q ecjuiti^ and fustice in health care —
L WHAT ARE THE INEQUAI.ITIEs Inh EALTH IN YOUR COUNTRY
4
a) What are the inequalities and inequities in health in your country^
Consider, for example:
- are certain groups particularly disadvantaged in
terms of health provision based on class, caste,
gender,
race, ethnicity, sexual orientation.
mortXer.l°XC0"°miC a"d S“SraI,hi“' <«®™« i" ^>h indicators such as mortality,
Is'™ “Ci0-'“"»"’i= and geographical differences in access to health care
’
- are there soeto-eeononne and geographical differences in the resources spent on health care
C^j
il^jL
W
-McCruujG
>
/v^^^-Zz4XK<r^*/?
<.Cx.y^c 'i
'tS'*
/n yj
-
C^-4-
t/Q^C Xvy
c^
ci ix
A-
//
6
^y/
rc
C
ulh Pj!mentation of treaties, conventions, plans of action etc.
For All sUaTgyTrthe' heahh provisioZonhe^6 intemati°nal agreements such as WHO Health
an°US internatlOna' COnfere"CeS °f the 1990s ^h
as Rio, Copenhagen, Cairo Beuhng etc
/
c
/y
c
./\L\ve
^<KLZ4/
V
Contact
ViSi°n 'nternat^al.
6 addresses:
Fax (41-22) 798 65 4’7’ '“ ■’Ourelle'CH-.12°9 Geneva, Switzerland
Dr. Alireza Mahallati. Treasurer, c/o The International Federation of the ReH r
"vl.gva@iprolink.ch
P.O. Box 372, CH-1211 Geneva 19 SwitzXV
S°CietieS'
Dr'
Tel. (41-22) 730 44 88
M,. Olovanni Ballerlo. "secretary, C. B.tel
T... (4,.22) M S4 „„
,,
F„
NGO FORUM FOR HEALTH
----- partnering to mahe heattk a
a reality
re a
e ? “ i t y and fuitice in keafth
keaftk care ___
Set’Ll a?y S(PeciflC examPles wl’"re these inequalities are being^mpounded by other factors
the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
I
/ /
, /
,
Cl
.
c^'l^Zc'X^
ZZc ^Za
1
lL
ck -CC
C-JUJ
v .A
r<
/7^^/
ZutLZLZ d
A2A~Z'(
y
/Z xiJV'i
^iZt^Xc t,^
> c Z cL'f 5
2. HOW WOULD y 6u MEASURE THESE INEQUALITIES
a) How would you show that these inequalities exist?
/
b) Which sources of data and information in your country can be used for monitoring?
-
o
c
i
c) What about the accuracy and transparency of Government data?
JZ-4L X 6V
■~C£ yr\
Z7\_
-^A'-yy^VC' cZ
^C4'Y^D
d) Is there a need for a primary collection of daZr would it be possible to analyse existing data?
C^-yt
c^ZZ^Zvti.
c^c K
C
e) How is it possible to gain access to this data?
r
n, C
'
n
rsu .
'
Cf
b—i
Contact addresses:
Te^S'l ViSi°n 'Tax Mil?) 7^8
Or. Allreza M«al. Tre„„rer.
l* v
CH?°9 Gen6Va ' Swtoedand
Red CroKS SSS'sSle.,
Tai
991 ?9n aa aa
P'°' B°* I72, CH-'1211 Geneva 19 Switzerland
Mr. Giovanni Bailerio. Secretary, c/o Baha'i intrXaESSSniJ, 15 rte.
r i
Tel. (41-22) 798 54 00
Switzerland
Fax (41-22) 798 65 77
C^WOrL-Sacconex
E-mail: gballerio@geneva.bic.org
4^
Ji
.^JBMLUL __________ _--——
NGO FORUM FOR HEALTH
•v
partnering, to make he a (th a reafity. -----
promoting equity and justice in keaftk care —
- 9 How wil1 il be Possible to verify if the data is reliable and accurate?
g) Is there a need to protect sources and
so how?
/Q.C
2
h) Who would monitor the data and how?
i) What are the cost implications?
Cr C
C^r\^(,’LA^^
C^C
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
^0
b) How can these issues be taken
L-
f^o / xgi
'
7‘
c) With whom should they be taken up?
■-----------------------------------------------------------------------------------------------------------------—
“■
m%“MW°r" V“iOn
M-.
8allerk>, S^,, M Bah.,
T«. (41.22) 798 54 00
^2/
T“,e"*' CH-1209 G«’™'
EK. ,5
Fax (41.2^
NGO FORUM FOR HEALTH
----- partnering to tnahe keafth a reality
promoting, equity, and juitice in health care
d) What is the likely impact of such initiatives? "
G)
---------------
f°r 3 altematezreP°rting astern whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
~y^o.
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind'’
b) What different roles could they play?
c>^
5. ORGANISATION
a) How would a national watch be organised?
r-v
4vi
^ir»i
^<.
4
Tel. (41-22) 798 41.83
M,. G..a„„, B.,.,,0. Secrelary, * Bate,
Tel. (41-22) 798 54 00
15 „,
Fax (41-22) 7^%^77
(41 22) 798 65 77
c
u ..
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
partnering
to
o make he a ft !i a re a (it
a re a
------
et^uitif. and fust ice in liea(tk care —
Leafth
j
b) What should be the structure?
6 o s
c) How should it relate to a global health watch?
<-ydf
&t/sVrx&, wt)
m
v
'T
Ca V tZ
c
T .
-C 01 <
< C~}
W-v ")
-□
'7U4'* -
5TvtL^c
j
Ce.
o**
d) How should the capacity of national ant} local NGOs from the South be
strengthened?
(J
z
e) How can a wide, sustainable and independent funding base be maintained?
- 77/'X- b Yeyp'b
c
6. All the above questions have been related to a National Watch, watching
nationally. Do you have any suggestions of how a National Watch can also
i
feedback on global^
economy, issues, processes and projects that affect National
Policies ie., South-North
jue - to whom and how?
y . dialog’
i
T
V
/IxZCk
7. ADDITIONAL POINTS
Have you got any other points you would like to raise either from a global or national
perspective regarding the creation of a Global Health Watch?
X-
x,vv\.b
z
-vjVt-rX
RETURN TO:
Dr. Ravi Narayan,
Community Health Cell,
Society for Community Health Awareness, Research and Action
No.367, 'Srinivasa Nilaya' Jakkasandra I Main, I Block, Koramaneala
Bangalore - 560 034.
Phone : (080) 553 15 18 & 552 53 72
Pax : (080) 552 53 72 Email : sochara@vsnl.com
)
Rl?c|R)£|lclt|
JAWAHARLAL NEHRU UNIVERSITY
JNU
s
NEW DELHI-110067
GRAM : JAYENU TEL. : 6*10 7676, 616 7557 TELEX : 031-73167 JNU IN FAX : 91-011-6165886
NGO FORUM FOR HEALTH
f
------ partnering, to
------ promoting eguitg
n9
make he a (th a rea fit y. -----a re a
and justice in lieaftk
lieafth care —
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
• Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
• It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
• Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
Organisation:
Address:
Telephone number:
Fax number:
E-mail
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Fax (41-22) 798 65 47
Tel. (41-22) 798 41.83
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha'i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
Q
NGO FORUM FOR HEALTH
--- partnering to male keaftk a reality -----promoting ec^aitt^. and justice in lie a ft li care —
I. WHAT ARE THE INEQUALITIES IN HEALTH IN YOUR COUNTRY
a) What are the inequalities and inequities in health in your country?
Consider, for example:
- are certain groups particularly disadvantaged in terms of health provision based on class, caste,
gender,
race, ethnicity, sexual orientation.
- are there socio-economic and geographical differences in health indicators such as mortality,
morbidity rates etc.
- are there socio-economic and geographical differences in access to health care
- are there socio-economic and geographical differences in the resources spent on health care
Impf^^ntalion of treaties, conventions, plans of action etc.
Is the Government fulfilling commitments made in international agreements such as WHO Health
For All strategy or the health provisions of the various international conferences of the 1990s such
as Rio, Copenhagen, Cairo, Beijing etc.
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
E-mail: wvi.gva@iprolink.ch
Fax (41-22) 798 65 47
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
------ partnering to
------ promoting equity.
make Leafth a reality -----and
lice in lie a (t It care —
c) Are there any specific examples where these inequalities are being compounded by other factors
such as the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
2. HOW WOULD YOU MEASURE THESE INEQUALITIES
a) How would you show that these inequalities exist?
b) Which sources of data and information in your country can be used for monitoring?
c) What about the accuracy and transparency of Government data?
there'a need for a primary collection of data or would it be possible to analyse existing data?
e) How is it possible to gain access to this data?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
E-mail: gballerio@geneva.bic.org
Fax (41-22) 798 65 77
(J
NGO FORUM FOR HEALTH
------ partnering, to make Leafth a reality. -----and j. nit ice in Leaf th care —
------ promoting equity
f) How will it be possible to verify if the data is reliable and accurate?
g) Is there a need to protect sources and is so how?
h) Who would monitor the data and how?
i) What are the cost implications?
a) Where can questions of inequality in health be taken up?
b) How can these issues be taken up?
c) With whom should they be taken up?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
----- partnering to
promoting, eguitg
make keaftk a re a fit g -----and fait ice in keaftk care —
d) What is the likely impact of such initiatives?
e) Is there a need for a alternate reporting system whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
b) What different roles could they play?
5. ORGANISATION
a) How would a national watch be organised?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
C
NGO FORUM FOR HEALTH
partnering, to make lie a (t h a re
re a
a (it g -----
h care —
promoting eguitg and justice in Leaf
lie a (tth
b) What should be the structure?
c) How should it relate to a global health watch?
d) How should the capacity of national and local NGOs from the South be strengthened?
e) How can a wide, sustainable and independent funding base be maintained?
■
MeV''’
Q ail /Lc
G
,, .
IH'. •- •
i. <• \ I c
CT’ i
Ir I
ye-
hr.C
! "j
■/
■
:
j
C
r*.
'e'
> id i. .
’
-c r
ADDITIONAL POINTS
Have you got any other points you would like to raise either from a global or national perspective
regarding the creation of a Global Health Watch?
RETURN TO: Drr-Erie Ram at the address below
r s -> ■ '■
‘/r
?1 C
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Ahreza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel.(41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
------ partnering to maLe lie a (th a re a fit
-----a re a
------ promoting, e g ait g and justice in
Leafth
th care —
in Leaf
0
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
• Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
• It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
• Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
/ccx
£>/<•
W^A ^I H
Organisation:
Address:
Floo #,
,
/Xr^X)
SAPA/V
r-r c, A
Telephone number:
D^O
Fax number:
E-mail
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
E-mail: gballerio@geneva.bic.org
Fax (41-22) 798 65 77
Tel. (41-22)798 54 00
NGO FORUM FOR HEALTH
------ partnering, to make lieaftli a reality ----------- promoting e gu.it g and justice in lie aft k care —
I. WHAT ARE THE INEQUALITIES IN HEALTH IN YOUR COUNTRY
a) What are the inequalities and inequities in health in your country?
Consider, for example:
- are certain groups particularly disadvantaged in terms of health provision based on class, caste,
gender,
race, ethnicity, sexual orientation.
- are there socio-economic and geographical differences in health indicators such as mortality,
morbidity rates etc.
- are there socio-economic and geographical differences in access to health care
- are there socio-economic and geographical differences in the resources spent on health care
J)
O-) /Q
^>0^
fe^Lt
o
•I
rC#'?
^^Y-f\O K
4
Cx^n< •
b) Implementation of treaties, conventions, plans of action etc.
Is the Government fulfilling commitments made in international agreements such as WHO Health
For All strategy or the health provisions of the various international conferences of the 1990s such
as Rio, Copenhagen, Cairo, Beijing etc.
/\0
\ 1 r
f r"" *
<0
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel.(41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
----- partnering, to maLe Leafth a reafitg -----
----- promoting eguitg and juitice in keaftk care -----
c) Are there any specific examples where these inequalities are being compounded by other factors
such as the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
'/Xc,
yy
<2
^2^-
Or
^7
(J
(A->)
A' *7
eke haJj*
2. HOW WOULD YOU MEASURE THESE INEQUALITIES
a) How would you show that these inequalities exist?
CX'Y^\
LA^>
b) Which sources of data and information in your country can be used for monitoring?
0
baW'
)
c) What about the accuracy and transparency of Government data?
(k
C.
-dUH^(7^
cx.><
d) Is there a need for a primary collection of data or would it be possible to analyse existing data?
I
/ Ae->e
v?
y>o
Co (/(^
e) How is it possible to gain access to this data?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha'i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
E-mail: gballerio@geneva.bic.org
Fax (41-22) 798 65 77
t
NGO FORUM FOR HEALTH
re a—
------ partnering, to make keaftli a
a re a
in heafth,
lie a (tli care —
------ promoting e g ait g and fuitice in
o
f) How will it be possible to verify if the data is reliable and accurate?
^Kere
(^.<9^
oAe^/oj,
v>\ C\
g) Is there a need to protect sources and is so how?
h) Who would monitor the data and how?
VW>
y'^.orr)
r)
(s-O-'V
a><
i^n3T<
(L-OU, cLu- <U?7
i) What are the cost implications?
6^-
t4^<y
-»
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
'c^c
>
ryvxP'vx^K O\f^^
yfL
b) How can these issues be taken up?
y7) zxa "
7^j 2-
vi/$> (
r
a v«
ZX<
>xZ
7
Cc^ -
c) With whom should they be taken up?
C/)
/z^ lcA$
d>
D^\
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
to maLe he a ft It a re atjty —
and j. a A lice in Leafth care —
promoting, ecju.
'ity
------
partnering
d) What is the likely impact of such initiatives?
k i^v'
■f
rr\^
e) Is there a need for a alternate reporting system whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
^f>roU'
&\Tt
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
b) What different roles could they play?
a
o Lg >
5. ORGANISATION
a) How would a national watch be organised?
»
■J
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22)798 54 00
E-mail: gballerio@geneva.bic.org
Fax (41-22) 798 65 77
'
NGO FORUM FOR HEALTH
•<
----- partnering, to ma L e health, a re a
----- promoting eguitg and iuitice in health care —
b) What should be the structure?
6
T\ 0
^f+41 ,
)
c) How should it relate to a global health watch?
^Xca
d) How should the capacity of national and local NGOs from the South be strengthened?
g3
7
1
>5 .
e) How can a wide, sustainable and independent funding base be maintained?
a^x
Net'
/
'C*
a )//
cT
J
de
r • ..
hr-.c
■2
I
'• •
!
ADDITIONAL POINTS
Have you got any other points you would like to raise either from a global or national perspective
regarding the creation of a Global Health Watch?
RETURN TO: Div Eric Ram at the address below
9> b r, •
• r
v U C
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
r ;
NGO FORUM FOR HEALTH
--------- partnering to make keaftli a re a fi t
th
care
—
and /nit ice in lie
ad
lie adt h
------ promoting. egaily.
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
• Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
• It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
• Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
Dr. Nerges F. Mistry
Organisation:
The Foundation for Research in Community Health
and
The Foundation for Medical Research
Address:
84-A R. G. Thadani Marg
Worli
Bombay — 400 018
Telephone number: 4934989 9 4932876 9 4938601
>
Fax number:
91-22-4932876/2662735
E-mail
frchbom@bom2.vsnl.net.in
frchpune@giaspn0l.vsnl.net.in
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
E-mail: wvi.gva@iprolink.ch
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
E-mail: mahallat@ifrc.org
Fax (41-22) 733 03 95
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
E-mail: gballerio@geneva.bic.org
Fax (41-22)798 65 77
Tel. (41-22)798 54 00
u
NGO FORUM FOR HEALTH
------ partnering, to ma he lie a (th a re a t g --------- promoting eguitg and fust ice in lie a ft li care —
I. WHAT ARE THE INEQUALITIES IN HEALTH IN YOUR COUNTRY
a) What are the inequalities and inequities in health in your country?
Consider, for example:
- are certain groups particularly disadvantaged in terms of health provision based on class, caste,
gender,
race, ethnicity, sexual orientation.
- are there socio-economic and geographical differences in health indicators such as mortality,
morbidity rates etc.
- are there socio-economic and geographical differences in access to health care
- are there socio-economic and geographical differences in the resources spent on health care
Refer to UNDP Report on : Diversity and Disparities in
Human Development : Key Challenges for India, January 1999.
b) Implementation of treaties, conventions, plans of action etc.
Is the Government fulfilling commitments made in international agreements such as WHO Health
For All strategy or the health provisions of the various international conferences of the 1990s such
as Rio, Copenhagen, Cairo, Beijing etc.
No. Government commitment is weak and it falls presy to pressure
from multinational agencies/grants. This is compunded by diverted
priorities, poor information base, uncommitted professionals and
an unaware citizenry.
Contact addresses:
Dr. Eric Ram, Chairman, c/o5World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza MahallatE Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
----- partnering, to
promoting eguitg
ft t ---
mctLe lie a ft !i a re a
and fuitice in Leafth care —
c) Are there any specific examples where these inequalities are being compounded by other factors
such as the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
Control of tuberculosis and malaria.
2. HOW WOULD YOU MEASURE THESE INEQUALITIES
a) How would you show that these inequalities exist?
It is time to move on from attempting to show that inequalities
exist. Their existence is apparent and unquestionable.
b) Which sources of data and information in your country can be used for monitoring?
Micro level studies from deprived sources and locations maybe
considered to monitor specific conditions that could scT/e
as indications.
c) What about the accuracy and transparency of Government data?
Inaccurate and not transparent.
d) Is there a need for a primary collection of data or would it be possible to analyse existing data?
Refer to Prof. K. Ramachandran, 45 Bakhthavalsalam Road,
Mylapore, Chennai 600 004. (Tel : 4994874).
A network of data collectors and disseminators need to be
formed. Perhaps a non-governmental annual publication of
Health Status of the Indian people needs to be published independently.
e) How is it possible to gain access to this data?
as in 2 d.
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
----- partnering, to make lie a ft li a re a fl t g ------- promoting eguitg and justice in lieaftli care —
f) How will it be possible to verify if the data is reliable and accurate?
g) Is there a need to protect sources and is so how?
Protection of sources would lead to lack of transparency
in the activity and would in all probability lead to lack
of reliability in data.
h) Who would monitor the data and how?
i) What are the cost implications?
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
Judicial intervention is becoming more frequent but sometimes
it is counterproductive and ill-informed. Academic meetings
addressing these issues are normally aimed at policy planners.
b) How can these issues be taken up? What is never said however is the
recourses one should take if representations fail : The efforts
must be redirected to create awareness amongst ordinary people
who Oifter all bear the onslaught of these inequalities. Health
must be one of the top priorities of a political agenda.
c) With whom should they be taken up?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
E-mail: wvi.gva@iprolink.ch
Fax (41-22) 798 65 47
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
------ partnering to maLe keaftk a rea (i t y ---and fudtice in keaftk care —
promoting, equity.
d) What is the likely impact of such initiatives?
e) Is there a need for a alternate reporting system whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
Yes. As
2 d and 2 e.
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
To be arrived at after consultation.
b) What different roles could they play?
5. ORGANISATION
a) How would a national watch be organised?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
(T
NGO FORUM FOR HEALTH
--- partnering to male lieaftli a readily. -----a re a
promoting, equity and j. u 31 ice in lie a dt !i care —
he a (th
b) What should be the structure?
<9
c) How should it relate to a global health watch?
d) How should the capacity of national and local NGOs from the South be strengthened?
e) How can a wide, sustainable and independent funding base be maintained?
r
■O*
he \C
de
h rC
f QO
c r9
.
Hr?
><2 I c I < r(
•' 1 j
c'hyt I
(
/e. ic
i
, .■
ft - 9‘
'
ADDITIONAL POINTS
Have you got any other points you would like to raise either from a global or national perspective
regarding the creation of a Global Health Watch?
RETURN TO: Dr-r-Eric Ram at the address below
C f-l C
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
E-mail: wvi.gva@iprolink.ch
Fax (41-22) 798 65 47
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
make he a (th a re a fit g -----a re a
and
justice
in
in lieaftli
keafth care —
promoting eguitg
----- partnering, to
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
• Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
• It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
• Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name:
Organisation:
fb owx
- g 6 OD
Address:
Kmi : 553 36qz
Telephone number:
Fax number:
0?>0 ~ <55 "io ^-7 7
E-mail
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
0
NGO FORUM FOR HEALTH
--- partnering, to make lieaftli a readily. -----a re a
promoting e g a it g and justice Ln
in he
he adt
a (thli care —
I. WHAT ARE THE INEQUALITIES IN HEALTH IN YOUR COUNTRY
a) What are the inequalities and inequities in health in your country?
Consider, for example:
- are certain groups particularly disadvantaged in terms of health provision based on class, caste,
(D gender,
race, ethnicity, sexual orientation.
- are there socio-economic and geographical differences in health indicators such as mortality,
morbidity rates etc.
5 - are there socio-economic and geographical differences in access to health care
are there socio-economic and geographical differences in the resources spent on health care
\ -
b) Implementation of treaties, conventions, plans of action etc.
Is the Government fulfilling commitments made in international agreements such as WHO Health
For All strategy or the health provisions of the various international conferences of the 1990s such
as Rio, Copenhagen, Cairo, Beijing etc.
<>
To”/.-
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
------ partnering to male leaf th a reafiti^ -----a rea
------ promoting, eguitg and j.u,6tice in
lielieaftk
a ft It care ------
c) Are there any specific examples where these inequalities are being compounded by other factors
such as the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
2. HOW WOULD YOU MEASURE THESE INEQUALITIES
(Vv'A'A'i
s Vcaa I A '^-€- MAyt<j
s
a) How would you show that these inequalities exist?
/>m vwv\^
p Uv\ (Lm
w
vudiR
• 'J
b) Which sources of data and information in your country can be used for monitoring?
MbcLl
—
C_ C_aaa />c
bxss
c) What about the accuracy and transparency of Government data?
-
s
V^rrwvvO ^j®<X4lvc
•— Me Hs
Zv Xyt ?
vr^o
3uld it be possible to analyse existing data?
d) Is there a need for a primary collection of data or would
S 0.^>
—
V< v Ta
)
*
- VAMkS lata?
e) How is it possible to gain access to this data*?
VA\>^r
^^V_5
r
eVv\dA' Wx c X‘ aa
sVcwt<d
- ’A* C£-v \aa
C^Vx -ytn -^Iatm ^ Gm
lpz>3r tvA/
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha'i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
------ partnering,
to make lieaftli a reality ------
------ promoting equity and justice in lieaftli care —
f) How will it be possible to verify if the data is reliable and accurate?
g) Is there a need to protect sources and is so how?
.-6^
?
h) Who would monitor the data and how?
i) What are the cost implications?
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
b) How can these issues be taken up?
---
pAxj
\MWU. VxA^vo
c^~4)
Xar-v-X ■
c) With whom should they be taken up?
GcrJL'
M- ^-\S V Ur c
'yi/v'
1)
V Vx tl/V V^^A<yv<,\^ ,
60
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
^rry,
NGO FORUM FOR HEALTH
(u.v---
------ partnering, to make keafth a rea
and luitice in keaftli care —
------ promoting eguitg
d) What is the likely impact of such initiatives?
e) Is there a need for a alternate reporting system whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
--5
Ia XJ2_c A
X-
SVtMV
AO
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
-t tmsj)
b) What different roles could they play?
5. ORGANISATION
a) How would a national watch be organised?
(S(<S V
4
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
Uc 'ytt Ja
NGO FORUM FOR HEALTH
to ma he keaftli a rea^iti^. -----ma
equity, and j.justice
a st ice in lieaftli care —
— partnering
— p
romotiny
b) What should be the structure?
s
c) How should it relate to a global health watch?
Mva Ua
umdp
d) How should the capacity of national and local NGOs from the South be
strengthened?
fA C\ O
Vvk
Wh'’
(TVAj'-e v
e) How can a wide, sustainable and independent funding base be maintained?
X/Wt/vC, '
6. All the above questions have been related to a National Watch, watching
nationally. Do you have any suggestions of how a National Watch can also
feedback on global economy, issues, processes and projects that affect National
Policies ie., South-North dialogue - to whom and how?
7. ADDITIONAL POINTS
Have you got any other points you would like to raise either from a global or national
perspective regarding the creation of a Global Health Watch?
RETURN TO:
Dr. Ravi Narayan,
Community Health Cell,
Society for Community Health Awareness, Research and Action
No.367, 'Srinivasa Nilaya' Jakkasandra I Main, I Block, Koramangala,
Bangalore - 560 034.
Phone : (080) 553 15 18 & 552 53 72
Fax : (080) 552 53 72 Email : sochara@vsnl.com
NGO FORUM FOR HEALTH
----- partnering to
make keaftli a reality. ------
promoting, egaitg and fuitice in keaftli care —
GLOBAL HEALTH WATCH
COUNTRY STUDIES
Questionaire for participants attending national meetings on the establishment of a Global
Health Watch
• Please read the background paper attached which looks at the issue from a broad perspective
and gives general thoughts on the need and prospects for setting up a Global Health Watch.
• It is now necessary to move ahead and consider more specifically how such a health watch
would function at the national level in terms of types of issues it would focus on and the ways
in which it would carry out its work.
• It would be very useful if you could complete the questionaire prior to the meeting as it would
be good preparation for the discussion itself. Please be as specific as possible in answering the
questionaire, highlighting particular issues and giving names of people, places, documents etc.
as relevant. Add additional sheets if necessary.
Please hand this questionaire to the organisers of the meeting as it will be returned to the co
ordinating committee of the NGO Forum for Health in Geneva.
Name: zX
Organisation: 6 /
Address:
Telephone number:
Fax number:
E-mail
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
Tel. (41-22) 798 54 00
1
NGO FORUM FOR HEALTH
------ partnering, to make lie a Pt It a rea (itg --------- promoting e g ait g and fast ice in lieaftli care —
I. WHAT ARE THE INEQUALITIES IN HEALTH IN YOUR COUNTRY
a) What are the inequalities and inequities in health in your country?
Consider, for example:
- are certain groups particularly disadvantaged in terms of health provision based on class, caste,
gender,
race, ethnicity, sexual orientation.
- are there socio-economic and geographical differences in health indicators such as mortality,
morbidity rates etc.
- are there socio-economic and geographical differences in access to health care
- are there socio-economic and geographical differences in the resources spent on health care
7b ^7-
b) Implementation of treaties, conventions, plans of action etc.
Is the Government fulfilling commitments made in international agreements such as WHO Health
For All strategy or the health provisions of the various international conferences of the 1990s such
as Rio, Copenhagen, Cairo, Beijing etc.
■VLbf'■7^777-^
7)^
Vt-
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
------ partnering, to male keaftli a rea/litg ------
J
------ promoting eguitg and ju.itice in keaftk care ------
c) Are there any specific examples where these inequalities are being compounded by other factors
such as the activities of private sector organisations, corruption and inefficiency in health
management, lack of public accountability, unequal allocation of health resources
2. HOW WOULD YOU MEASURE THESE INEQUALITIES
a) How would you show that these inequalities exist?
-
b) Which sources of data and information in your country can be used for monitoring?
c) What about the accuracy and transparency of Government data?
d) Is there a need for a primary collection of data or would it be ciswle to analyse existing data?
e) How is it possible to gain access to this data?
fyu'ft\AA______ 9/ Ttrvte -
■_________ /
7^-/- 7^^ '__________ _ ________
J Contact addresses:
/
I
/
'
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
Tel. (41-22) 798 54 00
NGO FORUM FOR HEALTH
----- partnering, to
make Leafth a reafity ------
promoting e gaily. and fustice in lieaftli care —
f) How will it be possible to verify if the data is reliable and accurate?
I
g) Is there a need to protect sources and is so how?
h) Who would monitor the data and how?
i) What are the cost implications?
3. ADVOCACY
a) Where can questions of inequality in health be taken up?
b) How can these issues be taken up?
c) With whom should they be taken up?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
E-mail: wvi.gva@iprolink.ch
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
— partnering, to male lieaftli a reafitg -----a rea
p
romoting eguitg and iu&tice in lieaftli
lie a ft li care —
d) What is the likely impact of such initiatives?
e) Is there a need for a mtemate reporting system whereby NGOs can provide shadow reports to
official Government reports (as in the Convention on the Rights of the Child for example)
4. PARTNERS
a) Which organisations and persons would be able to participate in monitoring of this kind?
‘ Lj<^^«
b) What different roles could they play?
5. ORGANISATION
a) How would a national watch be organised?
Contact addresses:
Dr. Eric Ram, Chairman, c/o World Vision International, 6 Chemin de la Tourelle, CH-1209 Geneva, Switzerland
E-mail: wvi.gva@iprolink.ch
Tel. (41-22) 798 41.83
Fax (41-22) 798 65 47
Dr. Alireza Mahallati, Treasurer, c/o The International Federation of the Red Cross and Red Crescent Societies,
P.O. Box 372, CH-1211 Geneva 19 Switzerland
Tel. (41-22) 730 44 88
Fax (41-22) 733 03 95
E-mail: mahallat@ifrc.org
Mr. Giovanni Ballerio, Secretary, c/o Baha’i International Community, 15 rte. des Morillons, CH-1218 Grand-Sacconex,
Switzerland
Tel. (41-22) 798 54 00
Fax (41-22) 798 65 77
E-mail: gballerio@geneva.bic.org
NGO FORUM FOR HEALTH
to make health a re a
----partnering
-------
m cl
- promoting, eguitg and justice in lieaftli care —
eci
4
b) What should be the structure?
c) How should it relate to a global health watch?
A
d) How should the capacity of national and local NGOs from the South be
strengthened?
e) How can^a
sustrnn^fele and independent funding base be maintained?
6. All the above questions have been related to a National Watch, watching
nationally. Do you have any suggestions of how a National Watch can also
feedback on global economy, issues, processes and projects that affect National
Policies ie., South-North dialogue - to whom and how?
1. ADDITIONAL POINTS
Have you got any other points you would like to raise either from a global or national
perspective regarding the creation of a Global Health Watch?
RETURN TO:
Dr. Ravi Narayan,
Community Health Cell,
Society for Community Health Awareness, Research and Action
No.367, 'Srinivasa Nilaya' Jakkasandra I Main, I Block, Koramangala,
Bangalore - 560 034.
Phone : (080) 553 15 18 & 552 53 72
Fax : (080) 552 53 72 Email : sochara@vsnl.com
Re: ghw
Subject: Re: ghw
Date: Mon, 18 Oct 1999 09:25:00 -0700
From: Eric_Ram@wvi.org (Eric Ram)
To: COMMUNITY HEALTH CELL <sochara@blr.vsnl.net.in>
Dear Thelma,
Could you please resend your attachments as a word for window 95
document, version 7.0. as we have some difficulties to retrieve it.
Many thanks.
Gladys for Eric Ram
Subject: ghw
Author: COMMUNITY HEALTH CELL
Date:
16.10.99 12:09
Reply Separator
sochara@blr.vsnl.net.in> at INTERNET
Dear Eric & Asmita,
Reg : GHW - National Meeting - India.
Greetings from Community Health Cell!
Just a note to keep you informed about the successful completion of the
National Meeting on Global Health Watch on 7/8th October 1999. Our
team is working on the proceedings and a compilation of the responses to
the questionnaire. We shall send this to you by the end of the month.
1 . The meeting was attended by 44 participants including 10 from our
local CHC network. There was great enthusiasm and we were overwhelmed
by the participation.
2. Five watches were represented in one way or the other. These were
Health Watch (A Women's health issues watch in India - post ICPD 1994);
Social Watch (via a fax presentation since neither Sundar nor
Jagadananda could attend due to some local constraints - however they
will be here end of the month for further discussions on collaboration);
People's Watch - a dalit oriented watch in Tamil Nadu; the People's
Union for Civil Liberties - Karnataka; and the North Arcot District
Health Intelligence - a watch initiative of Christian Medical
College-Vellore.
3. Six campaigners were represented - who had moved from 'watching' to
'advocacy' and lobbying for policy action. These were Tamil Nadu
Science Forum (which is lobbying to empower People to support the Back
to Alma Ata movement) ; Vimochana (lobbying for action to tackle violence
against women); The Anti Quinacrine Sterilisation Campaign (spearheaded
by the staff of the Centre for Social Medicine and Community Health of
Jawaharlal Nehru University;
the campaign against medical malpractice
by the medico friend circle group in Mumbai; the campaign and watch on
initiatives of bilateral / multi laterals in India by PEACE, New Delhi;
the campaign against female foeticide and so on.
4 . We had participants from Delhi, Mumbai, Pune, Chennai, Pondicherry,
Anand (Gujarat). While the Bangalore contingent was slightly larger
than initially planned many were representing institutions associated
with other networks and campaigns. Tamil Nadu had the strongest
representation and there is the potential of initiating a Tamil Nadu
Health Watch by networking among a host of ongoing initiatives as a
distinct possibility for 2000 AD. India may be too large to evolve an
effective watch too soon, but this meeting has generated an evolving
collectively and a core group will work on this process gradually.
1 of 2
10/20/99 11:54 AM
Re: ghw
5. The questionnaire was useful to get participants to think of the
issues in advance though many had some difficulties in the focus and the
implicit framework. The compilation is proving to be an interesting
challenge especially when respondents gave responses from different
perspectives
local, district, state, regional, national, global
perspectives. But the wealth of perspectives is rich and wide!
6. The National organisations were represented to some extent, CHAI was
represented by Fr. Jose, editor of Health Action, who will feature the
discussions and issues in the next issue. CMAI - Dr. Sukant Singh
chaired the session on Equity. VHAI - involvement was not possible due
to existing commitments.
PRIA and VANI were preoccupied with some
recent post-election developments affecting NGOs and the FCRA Act and
could not attend even though they were keen to. CSE was expected to
participate because of their phenomenally successful Environment
watching but Anil Aggarwal - who was attending - called it off - because
of an unfortunate recurrence of cancer and sent a note at the last
minute.
7. We are forwarding separately a copy of the final programme and the
participants list. A copy is also being posted to you. The rest will
come with the proceedings (a tentative content list of the proceedings
is enclosed).
We enjoyed
forum,
the opportunity to collaborate with the International NGO
All the best from the CHC team,
Yours sincerely,
Dr. Thelma Narayan
2 of 2
Dr. Ravi Narayan.
10/20/99 11:54 AM
ghw
Subject: ghw
Date: Sat, 16 Oct 1999 12:09:24 +0530
From: COMMUNITY HEALTH CELL <sochara@blr.vsnl.net.in>
To: Eric_Ram@ccmailgw.wvi.org, naik@ifrc.org
Dear Eric & Asmita,
Reg : GHW - National Meeting - India.
Greetings from Community Health Cell!
Just a note to keep you informed about the successful completion of the
National Meeting <on Global Health Watch on 7/8th October 1999. Our
team is working on. the proceedings and a compilation of the responses to
the questionnaire. We shall send this to you by the end of the month.
1. The meeting was attended by 44 participants including 10 from our
There was great enthusiasm and we were overwhelmed
local CHC network.
by the participation.
2. Five watches were represented in one way or the other. These were
Health Watch (A Women's health issues watch in India - post ICPD 1994);
Social Watch (via a fax presentation since neither Sundar nor
Jagadananda could attend due to some local constraints - however they
will be here end of the month for further discussions on collaboration);
People's Watch - a dalit oriented watch in Tamil Nadu; the People's
Union for Civil Liberties - Karnataka; and the North Arcot District
Health Intelligence - a watch initiative of Christian Medical
College-Vellore.
3 . Six campaigners were represented - who had moved from 'watching' to
'advocacy' and lobbying for policy action. These were Tamil Nadu
Science Forum (which is lobbying to empower People to support the Back
to Alma Ata movement) ; Vimochana (lobbying for action to tackle violence
against women); The Anti Quinacrine Sterilisation Campaign (spearheaded
by the staff of the Centre for Social Medicine and Community Health of
Jawaharlal Nehru University;
the campaign against medical malpractice
by the medico friend circle group in Mumbai; the campaign and watch on
initiatives of bilateral / multi laterals in India by PEACE, New Delhi;
the campaign against female foeticide and so on.
Mumbai, Pune, Chennai, Pondicherry,
4 . We had participants from Delhi, Mumbai,
Anand (Gujarat). While the Bangalore contingent was slightly larger
than initially planned many were representing institutions associated
with other networks and campaigns. Tamil Nadu had the strongest
representation and there is the potential of initiating a Tamil Nadu
Health Watch by networking among a host of ongoing initiatives as a
India may be too large to evolve an
distinct possibility for 2000 AD.
effective watch too soon, but this meeting has generated an evolving
collectively and a core group will work on this process gradually.
5. The questionnaire was useful to get participants to think of the
issues in advance though many had some difficulties in the focus and the
implicit framework. The compilation is proving to be an interesting
challenge especially when respondents gave responses from different
perspectives - local, district, state, regional, national, global
perspectives. But the wealth of perspectives is rich and wide!
6 . The National organisations were represented to some extent. CHAI was
represented by Fr. Jose, editor of Health Action, who will feature the
discussions and issues in the next issue. CMAI - Dr. Sukant Singh
chaired the session on Equity. VHAI - involvement was not possible due
to existing commitments. PRIA and VANI were preoccupied with some
recent post-election developments affecting NGOs and the FCRA Act and
could not attend even though they were keen to. CSE was expected to
participate because of their phenomenally successful Environment
1 of 2
10/28/99 6:17 PM
ghw
watching but Anil Aggarwal - who was attending - called it off
because
of an unfortunate recurrence of cancer and sent a note at the last
minute.
7. We are forwarding separately a copy of the final programme and the
participants list. A copy is also being posted to you. The rest will
come with the proceedings (a tentative content list of the proceedings
is enclosed).
We enjoyed
forum,
the opportunity to collaborate with the International NGO
All the best from the CHC team,
Yours sincerely.
Dr. Thelma Narayan
2 of 2
Dr. Ravi Narayan.
plGHW Proceedings list.doc
Name: GHW Proceedings list.doc
Type: Microsoft Word Document (application/msword)
Encoding: base64
Q GH W-PROCEEDINGS .doc
Name: GHW-PROCEEDINGS.doc
Type: Microsoft Word Document (application/msword)
Encoding: base64
10/28/99 6:17 PM
Global Health Watch
Subject: Global Health Watch
Date: Thu, 4 Nov 1999 16:23:00 -0800
From: Eric_Ram@wvi.org (Eric Ram)
To: sochara@blr.vsnl.net.in
CC: naik@ifrc.org
To: Dr. Thelma Narayan
To: Dr. Ravi Narayan
Dear Thelma and Ravi,
Thank you very much for your kind note of October 16, 1999. I am
very happy to learn that the National Meeting on Global Health Watch
turned out to be such a success with 44 enthusiastic participants
attending it.
I am glad also that both VHAI and CHI were represented, The list of
participants is impressive.
We are keenly looking forward to receiving the report and the
proceedings of the conference and the compilation and analysis of
the responses to the questionnaire. Can you please send a copy in a
diskette along with a hard copy, (word for windows 95, version 7.0
or in wordperfect 7.0)
The Africa Regional meeting has also taken place in Harare and we
are awaiting their report as well.
The pre European Regional meeting took place in the form of
Intercollegiate Forum on Poverty and Health about the same time as
yours. Their big meeting will be in March 2000.
The North and South American meetings will also take place in the
first quarter of 2000. We will be a bit late in completing the other
regional meetings but I am quite pleased with the progress we have
made thus far. And, there is a growing interest internationally on
Global Health Watch.
Once again I want to thank you very sincerely for your hard work in
organizing these meetings.
With my warm greetings and best wishes.
Sincerely,
Eric Ram
m V’
11/4/99 10:07 PM
Re: hello
Subject: Re: hello
Date: Mon, 3 Jan 2000 23:56:06 +0530 (1ST)
From: Muraleedharan V R <vrm@acer.iitm.emet.in>
To: chc <sochara@blr.vsnl.net.in>
Dear Ravi/Thelma:
I have read the draft guidelines of the RBM meeting. I was part of the
discussion on "role of private sector" and "Research and Development"
(guidelines 5 and 10, respectively). I think the draft cover very much
what we discussed in the meeting. It only requires some editorial
corrections.
I shall soon send my comments, if any, on the notes on Global Heatlh
Watch.
I read Andy haines and Iona heath's article on poverty and health, BMJ, 1
March 2000.
with regards
Muralee
V.R.Muraleedharan, Ph.D.
Associate Professor of Economics
Dept of Humanities and Social Sciences
Indian Institute of Technology, Madras 600 036 India
Tel: +91-44-445 8443 (work)
Fax: +91-44-235 0509
E-mail: vrm@acer .iitm.ernet.in
1 of 1
1/4/00 9:49 AM
T^^-gvc.
e
j?.
rlk cp U______
AJ^.
o g,
a
A?
f4
4? a
r. /k- R
f~>
//C^^
tfy’z 1
cyt&^ZA
T'£-f=^crf>
C t?
^r
o
^^_Jk
ed ,
/AJhxZ^^)^
t ll^hc^rj
A
I .TcJ pt
T^lczl
C- (^f
f'-'CcJi?) >- /v ?- <at ■
K
O^c.
}
sLX^. fL
^■
^xJL
7*
e
/nr, A
^‘‘Zl
c^pr
&
1
/^votx
4-
^L
T7
A^-J
cn.
d!
c-^-^_r->~4-cC
>_ CovC-g'-vo-p cJ
A^CL
a
f^S^-CC]*
(/^d
<^L
■L
-
/yi & Q,
,A<.\dJ
K)\
itk
P£>
ACrsJ?
fo_ k <
■k
2
P'l
/^~) lsr>
P-
sg^
^w~
^Zti
^Xc4
rxxcj
rSL
<g
AiE C^CD C-C?^^
—22?
T
^=* p
f
d
■f» (-'[/'
h
^tor/^1
< «*- a /fe
■^py cj it
etctl^>^Ct\
?
Ch
A<
tz
'
■>
t
s »—
Crc^ )
c cd e g ^
r~^a iZ>i2^CT~ 57A-1 oCy
c(
A^j' L c^cJL^ck-, r
C^-fcJL^ O>a JqQ
^L.
1£_A
4 l^J^L
C f~V*^ Cl fT-CP-
x?
TO'
k /?*? Ytr
j^As.
lc\______ _
tax sent by
lUbVlls.
IIUllVl
•*» •
DC.L.MIUII
g ~Cc
Lz) c-/
CUG.
Cd
r-l i
c
(L'P
.^2
■o c
E E.E
AV
Community Health Cell
Bangalore
India
Dr. Ravi Narayan
Fax : 080,55.333.58
Brussels, 3lh of December 1998
Dear Dr. Narayan,
The contribution and Initiatives you gave to the start of a Global Health Watch
have impressed us, as Medlcus Mundi we hope that the NGO Health Forum is
receiving the proper means to start the feasibility study.
In your fax dated 3th of July 1998 you put the question how CHC could
become a member of MMI.
Medlcus Mundi International is very much willing to have members from low
Income countries. They have, however, to face certain conditions as good
sustainability, PHC oriented and not-for-profit acting.
CHC seems to correspond to these conditions.
Recently, a NGO In Benin, AMCES, has officially become an associate
member' of MMI.
MMI has formulated In the statutes two types of membership:
1. full member with the right of vote and paying full contribution, and
2. associate membership, with full participation In the MMI network,
conferences and assemblies, but without the right of vote and paying a
voluntary 'pro forma' yearly contribution according to their financial
,
L
, , .
possibilities.
We would like to know If CHC is still interested In such an (associate)
membership. If so, and we really are very much inviting you to do so, we
Invite you to contact us and start the application procedures.
Tell us what MMI can do for you, what your expectations are and what we
could offer in our MMI network.
ve our best regards.
l^)r.^Me Rypkeipca
ror Medicos MurvJII International
ivt dts Ik'ti* Lgliseii. 04
12III Bruxelles
I’htw 142-2-2.A1.06 <IS
Ins. +3? 2 231.I* 52
nicdicUMnuixli^'ngiiiiet be
hup://www.iiit<lifH'<iHniKli.iHi:
Im ii Ii htt'txihl
35
\
InleriMlhiMl (M ganglion
for cwpcralion in health carc
III offiviitl idiilii'iiN
with WHO
leMiluiioii cbft.lr27
7^
27
c? / -ri
A->
er
Cr>
y
?.|
GLOBAL HEALTH WATCH
NATIONAL MEETING : INDIA, T'" - 8“’ October 1998
Community Health Cell - Bangalore
and
NGO Forum for Health - Geneva
Venue : Ashirvad, 30, St. Mark’s Road, Bangalore - 560 001. Phone : 2210 154
Tentative Programme
7th October 1999
(Thursday)_____
8.3O-1O.OO a.m.
Session 1
10.00 - 11.00 a.m.
11.00- 11.15
Session 2
11.15 a.m. - 1.15
p.m.
Registration and Fellowship_______
Chairperson :
Introduction / Inauguration
Dr. V. Benjamin, CHC.
• Welcome
• Self Introduction by Participants
;
• Introduction to the theme and
Objectives of the Workshop
• A Presentation on the GHW idea
• Finalisation of Programme
• Selection of Rapporteur Team
Tea / Coffee____________________
Chairperson :
Learning from Other Watches
Dr. C.M. Francis, CHC
i.
ii.
iii.
IV.
V.
vi.
1,15 -2.00 p.m.
Session 2 (Contd.)
2,00-3.00 p.m.
Health Watch
Social Watch
Dr. Gita Sen
Dr. Sunder Misra / Mr.
Jagadananda
NATHI- District level Disease Dr. Reuben Samuel
Surveillance
Mr. M.A. Britto
People’s Watch (Tamil Nadu)
Prof. Hasan Mansoor
PUCL - Karnataka
CSE Nominee
'Environmental' Watch
(Each presentation of 15-20 minutes
will be followed by 10 minutes of
clarifications / questions)_____________
Lunch___________________________
Presentations will continue with sharing
other
regarding Participants to volunteer
by
participants
‘Watching* on issues in their work.
D:\OFFICE\September 99 letters.doc
Session 3
3.00 - 3.20 p.m.
3.20-3.40 p.m.
3.40 - 4.00 p.m.
4,00 - 4.15 p.m.
Session 4
4.15-5.45 p.m.
P11 October 1999
(Friday)_______
Session 5
9.30- 11.30 a.m.
Understanding Equity (including Chairperson :
Case Study of Government Health Dr. Sukant Singh, CMA1
Data) - A Panel discussion
Panelists
Dr. Pankaj Mehta
What is Equity?
Equity in National Health Programmes Dr. Ravi Kumar
in
Health Mr. As Mohammad
Equity
Government
Information________________________
Tea / Coffee ____________________
Group Discussion -1
Moderators/Resource
Inequalities / Measurements / Sources of persons to be selected
Information / Analysis for GHW
for each group
Evolving the Framework of a Watch(I)
a)
b)
11.30-11.45
Session 6
11.45 a.m. - 1.15
p.m.
1.15- 2.00 p.m.
Session 7
Plenary : Presentation of Group
Discussion
Advocacy / Campaigns
Case Studies
Tea / Coffee________________
Group Discussion II
Themes
Organisational /
/Advocacy / Partners for GHW
By Rapporteurs
A short presentation by a
few participants selected
some
for campaigns/struggles.
(Participants
to
volunteer)
Action
Lunch____________________________
Evolving the Framework of a Watch (II)
2.00 - 4.00 p.m.
Chairperson :
Prof. R L. Kapur, CHC.
Moderators/Resource
persons to be selected
for each group.
Chairperson :
Srinivasa,
Dr.
D.K.
RGUHS.
Plenary Meeting:
By Rapporteurs
a) Short Presentation by Groups._______
b) Presentation of responses to pre Dr. Sunil Kaul /
workshop questionnaire. Suggestions Dr. Rakhal Gaitonde
from the Floor.
4.00 - 4,15 p.m.
Session 8
4.15 - 5.15 p.m.
Tea / Coffee________________________
The Way Ahead - to Watch and how Chairperson :
Mohan
Dr.
to Watch? at India level
Suggestions & Commitments on Follow NIMHANS.
up.
Winding up
D:\OFFICE\September 99 letters.doc
Isaac,
dr no Yd <4 2- D-
inc’ia
http://www.socwatch.org.uy/1999/eng/informcs_nacionales_99/ind99cngh'
INDIA
S '/A ('m PI fS
P
io
c-
H
l-i: Pc/C7S
COMMITMENTS: A BARREN FLUENCY'?
Jagadananda
Sundar N.Mishra
Economic reforms and liberalistion is nearing a decade in India. These years have
been marked by a consistent effort to link up with international economy and spur
on economic growth. While there has been adequate mouthing of social concerns,
liberalisation agenda have never been accompanied by corresponding social
development policy and programme initiatives to specifically cushion/further the
interests of vulnerable communities. While Copenhagen declaration had been
supported with zeal it has never seemed to be a signal guiding influence in chalking
out policies and programmes. Now, standing at the completion of a quinquennium
of the Social Summit, it is important to look back at the situation and
achievements with respect to different commitments. We attempt to take a
summary look below which is broadly categorised into four thematic domains.
BASIC SERVICES AND HUMAN SUPPORT
1. Education: The Basic Enabling
The educational situation in India marked by a literacy rate of 52.21%, and a lag o
female literacy of about 25 percentage points indicates the distance to the goal of
education for all. This becomes particularly challenging as the depressed sections
(37% literacy for the schedule castes and 30% for scheduled tribes) have been
deeper in illiteracy.
Universalisation of primary education has been sought to be achieved by increasing
the number of formal schools, non formal education centres, launching a volunteer
based total literacy campaign targeting adults and supporting the programmes
through capacity building of personnel and innovating teaching-learning materials
and methodology. Women have been treated as a special target group.
Between 1991 and 1996, the gross enrolment ratio at the primary and upper
primary level have shown annual growth rates of 0.4% and 2.6% respectively. At
the secondary level it.has grown annually by 2.8%. Over the same period the drop
out rate have not come down considerably, (by 15.2% at the primary whereas only
by 8.2% and 2.3% at the upper primary and secondary levels). Enrolment in higher
education (general + professional) has grown by about 18% against an estimated
population growth of about 14% in the relevant age group.
Educational attainment has largely been sought to be achieved through enhancing
the formal system of schools etc. Comparatively the attempt through informal
means for elementary and adult education has been small. The management of
education remains the business of a centralised educational bureaucracy where the
role of civil society organisations is limited to only implementation of certain
programmes. Though in many of the states the self- governance institutions
(Panchayati Raj Institutions) are now made responsible for primary education, the
lack of resource and technical support disallows one to be optimistic in this
respect.
Apart from other functional difficulties, the sheer financial crunch (an estimated
shortfall of Rs. 32 billion in 2000) will hamstring this ponderous system to extend
india
http.7/www.socwatch.org.uy/1999/eng/informcs_nacionales_99/ind99eng li
beller quality primary education.
1.2 Health, Sanitation and Potable Water: wellbeing for Momentum
The illusive goal of Health for All by the year 2000 have been restated as ’Health
for Under privileged by 2000 which is however unlikely to be achieved. Basic
health services are sought to be provided throughout the country by a three-tier
institutional structure comprising primary, secondary and tertiary health care
facilities with appropriate referral linkages. The system spans the whole stretch
from community level to district and state levels and includes super-specialty
facilities in urban areas.
But this system has fallen short of adequacy considering the objective of health for
all. The number of institutions at the primary level suffer from combined shortfall
of as many as 31601. The medical/paramedical personnel manning these centres
number only 53.6% of the requirement. Only 11.2% of the specialist positions
required have been filled up. These shortfall are most accentuated in remote areas
where no alternative facilities are available.
Public investment on health though rising in absolute terms, has declined to as low
as 1.6%. of plan expenditure. The investment has shown an urban bias. While
three-fourths of the population live in rural areas, two-thirds of hospitals are in
urban areas. Only around 200 hospital beds are available per million population in
rural areas as compared to 2180 in urban areas (1993).
Notwithstanding these negative trends, the health situation has somewhat lookee
up. Access to basic care is enjoyed by 85% of (UNICEF, 1996) people. Infant
mortality rate has come down from 80 in 1990 to 72 in 1996. Crude death rate has
come down from 9.6 to 8.9. Under 5 mortality is still 93 for male and 108 for
female children. Life expectancy has risen from 58.1 years in 1990 to 62.4 in 1996
for men and from 59.1 to 63.4 for women. However, 16% of total population arc
not expected to reach age 40 as against a world average of 13% (Human
Development Report, 1998, UNDP)
The problem of shelter lessness and bad sanitation worsens the health situation. Up
from 31 million people in 1991, 41 million (close to 80% of them in rural areas)
will have no proper roof over their heads by the time next century begins. About
40% households had unclean or no water supply. There was no electricity for 69%
rural and 23% urban households. About three fourth of households had no access
to sanitation, this blea scenario brings out the ineffectiveness of the National
Housing Policy. The goal of eradicating hosuelessness has seen scanty follow up
action. The special programmes providing shelter to the weaker sections are totally
insufficient and public spending on this aspect has been out of step with the
requirement.
1.3 Food Security: The Groundwork of Growth
The food security situation seems to have improved with 94.5% of rural and
98.1% of urban households reporting adequate availability of food (two square
meals a day) in 1993-94. This picture shrouds a dire nutritional profile. More than
60% of the children suffer from protein energy malnutrition. Pregnant women
largely (50-90%) suffer from anemia. Women in poor families experience energy
deficits of 1000 calories per day during pregnancy.
*>
*7
india
http://www.socwatch.org.uy/1999/eng/infonnes_nacionales_99/ind99cng lr
The strategy for reaching ’food security for all’ broadly has three components: a)
growth in food grain production, b) widespread distribution targeting the weaker
sections, c) guarding against loss of entitlement by raising purchasing power. The
growth rate in total food grain output has slid to reach an annual rate of mere
1.2% in 1995-96. Adding fuel to fire, the agricultural export in cereals has posted a
rising trend (35% in 1995). The public distribution system with rising number of
outlets continue to benefit mostly the non-poor in urban areas. While growth and
distribution aspects of the strategy do not appropriately further the food security
goals, the attempts to improve the ability of the poor to ’earn’ food is also not
adequately furthered through employment and livelihood support programmes.
2. SUSTAINABLE LIVELIHOOD
2.1 Rights to Resource Use : Assets to Assert
Land is an important productive asset for the rural poor who are more than three
fourths of all poor and their number is on the increase. The trend of concentration
of land in a few hands is continuing in the 90s. The percentage decline in the
average size of marginal holdings is much higher than the per centage decline in
the average size of large holdings. This indicates the marginalisation of peasantry
making access to land for agricultural households difficult.
Against such background, the land reforms initiatives of the government have not
yielded desired results. The areas redistributed till 1996 accounted for only 1.5%
of the net cultivated area and assignees 3.5% of the poor. Most of such holdings
are unlikely to provide economic sustenance to the beneficiaries. Despite tenancy
being banned in several states the area under concealed tenancy is increasing and
there is a hike in rent in many areas. It has been established that there are about 15
million concealed tenants going without any legal protection.
Another important intervention through legal and administrative arrangements is to
arrest land alienation of tribal farmers (an estimated target population of 63
million). These efforts have so far fallen flat because of the inbuilt loopholes. The
current initiative to amend the land acquisition act, 1894 to expedite land
acquisition for different ’development’ projects will further endanger the land-based
livelihood of a vast number of poor.
A sizeable chunk of people (including, of course the tribal population) depends on
forest produces for livelihood. While the forest management system of government
had been hostile to these people, from 990 onwards a new framework of joint
forest management has been introduced which gives certain usufructuary rights
and a stakeholder status to these people. The JEM results have been mixed and
often the people have been taking up protection responsibilities without being able
to meet their livelihood needs. There has been a radical enactment i.e. the
Panchayats (Extension to Scheduled Areas) Act., 1996 giving the ownership right
over minor forest produces to local self governance institutions. However, the
governments at the country and provincial level are dragging their feet in so far as
the implementation of the new legal provisions in favour of the forest dependent
poor communities is concerned.
2.2 Employment: Working Poverty Away
The Indian Labour force has grown by about 27% between 1990 and 1997. If
future projections are considered, 10 million new jobs need to be crated per annum
india
iiitp://www.socwatch.org.uy/1999/cng/informes_nacionalcs_99/ind99eng Ir
at the very least. Against this backdrop the organised sector has provided only 1.6
million jobs throughout the 90s (upto March,! 997). In fact the average annual
rate of growth of organised sector employment has sharply decelerated from
1.68% during the 80s to merely 0.82% during the 90s (1990-97). So it is the
informal employment sector which absorbed most of the work force in the 1990s
(about 92%).
This vast opportunity lag for employment is sought to be eased for the poor by the
government through self employment programmes (SEPS) and wage employment
programmes (WEPs). SEPs provide credit and subsidy for procurement of income
generating assets and also develop employable skills of beneficiaries. The WEPs
provide casual manual work through public works programmes.
The SEPs have reached about 3 million households annually as an average during
1991 - 1996. The NSS data suggest that participation in SEPs (IRDP) increased by
18% for STs and declined forSCs by about 10%(between 1987-88 and 1993-94).
Though it has been seen to be taking families above the poverty lines various
evaluation studies have demonstrated that much of it has gone to less poor and
even not infrequently to families above poverty line. The WEPs over the same
period have generated person days of employment adding upto about 3.3 million
jobs annually on an average. This only indicates the vast shortfall which still neet
to be met. On the contrary, these are without any sustainability. The NSS data
suggest that participation in WEPs declined by 28% among STs, stagnated among
SCs and declined by 5% for others (between 1987-88 and 1993-94). The assets
created through these programmes in about one fourth of cases have been found to
be ’missing’ and others of hardly any income generating potential. Considering the
widespread leakage and dubious targeting it is difficult to determine precisely what
benefits they have caused to the poor.
Real wages in the unorganised sector fell in the rural areas almost throughout the
last decade, while it rose in agriculture till 1992 and then continued to fall. In the
dualistic labour market in India, the governmental wage policy favoured the
microscopic well paid organised segment and cold shouldered the expanding
unorganised sector. The practice of wage determination for the
unorganised/informal sector across the states and regions has belied the concerns
of ensuring basic subsistence of workers which can be attributed to concerns for
employer’s capacity to pay or political expediency. On the other hand, the practices
of setting minimum wages in the organised sector have moved beyond the
concerns of basic need or even the ’fair wage’ to higher levels of living wage.
Moreover wages in the organised sector are provided with fuller cost of living
adjustments which does not accrue to overwhelming majority of the workforce in
the informal sector. Thus one comes across the phenomenon of minimum wages
for the unorganised sector not being revised for years together which is further
worsened by the weak enforcement of the existing wage rates.
Most of the protective legislation apply to workers in the formal sector. Those
relating to stipulating of minimum wages, disputes on wages, non-discriminatory
remuneration, payment of wages, maternity benefits etc. have uncertain influence
on and little implementability for the informal sector workers.
In the face of job loss and redundancy, the concept of employment security has
seen some policy action in the industrial sector through the National Renewal Fund
in the form of worker counselling, retraining, redeployment and labour
reconversion, there is little information available with respect to its actual
4 of 7
indii
http://www.socwatch.org.uy/1999/cng/informcs_nacionalcs_99/ind99eng hi
effectiveness. Outside the industrial sector the WEPs and SEPs are the only
programmes which help workers to survive, not to talk of employment security.
3. PARTICIPATION/PARTNERSHIP AND GOVERNANCE
the constitution emphasized a decentralised structure of governance from the very
beginning which was to be realised through self- government institutions from the
local (village) level onwards. At long last, such system (the Panchayati Raj system)
came into being with constitutional status in 1993. These institutions are now
empowered to carry out development planning, implementation and other agency
functions which will meet the state system at the macro provincial level. Such
institutions are targeted to usher in citizen’s role in governance in a big way. But
the system is operationalsied in such a manner that these institutions do not enjoy
functional, administrative and financial autonomy. In most states the functions can
be amended/overridden by the governments. Relevant provincial level acts
empower the state to inspect, enquire into and suspend Panchayats resolutions.
Financial autonomy is also not granted to the Panchayats so far, though the centre
has accepted the recommendation of the tenth finance commission for adequate
allocation. On the otherhand, the Centre has been using Panchayats as agencies to
distribute grants meant for schemes sponsored by the central government. Such
schemes by becoming the orders of the Centre smother local initiatives. The Acts
giving ownership rights over local resources (land, forest, water etc.) to local
bodies especially in areas dominantly populated by indigenous and tribal people
making have been dilutcd/obstructed by the Central/Provincial governments.
Apart from this the record of involvement of citizens and civil society
organistaions in development, planning and programme management has been
dismal. Beyond a role in strait jacketed implementation nothing much has came
about. There is no institutional role of CSOs in planning, designing and
management of development under the state auspices. There is an operational
space for CSOs which often depends upon discretion and patronage of the
government, whenever this involvement goes beyond implementation it stops at
’democratic consultation’ without incorporating any dimensions of decision
making.
4. GENDER SENSITIVITY AND EQUITY
Primary education and total adult literacy is pursued with a special focus and
incentives on girls and women. Enrolment ratios and drop out rates are still
unfavorable to girls; but the Girls Boys Disparity Index (GBDI) has improved for
girls by 5 percentage points in enrolment ratios at primary and secondary levels.
The fall in drop out ratio has been quicker for girls than the boys. Growth in higher
education has been higher (24.1%) for girls as compared to boys (18.1%).
In the domain of health, programmes to extend health care specifically to girl
children and mothers exist which are improving in performance despite being
plagued by inadequacy of resource provisions. Though food security has
improved, it is difficult to say how the women have gained. Since women suffer
from intrafamily and intragender discrimination the current picture of household
food security might be glossing over far greater deprivation of women. This
problem has attracted little policy action over the years.
while labour force as a whole showed a confirmed tendency towards
informalisation, the little growth (little above 1%) that occurred in the organised
india .
h(tp://www.socwatch.org.uy/1999/eng/inforincs_nacionalcs_99/iiid99cng h
sector in the 1990s was favourable to women, who registered a numerical growth
of 8%. But women continued to suffer discrimination at workplace. About 50% of
women in India perceive themselves as victims of discrimination, according to a
study by
National Commission on Women (NCM). Even in the organised sector, womei
earned 23% less than men. As much as 64%n of the gender gap in earnings was
brought about by discrimination while about 36% could be attributed to
differences in productive endowment. The situation in the unorganised sector is far
deteriorated with women getting sometimes as less as 50% in comparison to men.
Looking at policy action to reduce gender inequity one does not come across an
encouraging picture. The reports of various pay commissions instituted by
governments at different periods of time give no indication of any systematic
attempt to consider the prevalence/extent of men-women wage differentials in any
given job/occupation in arriving at new pay scales. The Equal Remuneration Act,
1976 seeks to provide for equal remuneration and prevention of discrimination
across the sexes. Though the act straddles all employment sectors including the
informal, its vagueness in defining work equality allows for disparities to escape
with impunity. Minimum wages under the Minimum Wages Act, 1948 have not
been revised regularly as required and the wage rates fixed by many states in
sectors with women worker concentration fall below the levels suggested by
National Commission on Rural Labour (1993). While women in the organise*
sector enjoy reasonable maternity benefits, there is now a provision made by
central/state governments a kin to paternity leave. But in the unorganised sector
women face job loss, and undernutrition. There is some respite given by some state
governments in the shape of a maternity allowance for upto two children to
rural/urban poor women. Similarly, the payment of compensation, provision of
creches etc. have been availed of by women in the organised sector to some extent
which is not available to women in the unorganised sector. The investigation of
employer s compliance with various labour- protective legislation discussed above
is not done regularly reducing many of the entitlement to mere promises
particularly for women. Another collusive factor is that the labour unions have
viewed the survival of women labour as more important than achieving gender
equality, in wages, employment and their access to social security. Thus equity in
above lines remains a distant goal only.
Women’s access to different tiers of democratic power and the systems of decision
making has shown little improvement and promises which at the same time
illustrate the limitations. Political parties do not have appropriate
policies/inclination to raise women’s access to elective offices. The Women’s Bill
seeking to give more access to women to political party positions and to the
Legislatures has wobbled in the Parliament all along for the
last few years without getting required endorsement by party
leaders/representatives. Only exception is the local self governance structure of
Panchayati Raj where one third of the representatives are women. Political parties
have a poor profile of women leadership (less than 8% of top party pasts) at the
national level.
Percentage constitution of women cadres in the development administration, the
police system and the diplomatic corps improved by about 10% in the 1990s. The
presence of women in the top judicial system remained quite marginal (about 3%).
While reservation for women in these positions has helped to some extent, lack of
6of7
india
http://www.socwatch.org.uy/1999/eng/informcs_nacionalcs_99/ind99cng In
.
i
training and other facilities for capacity building has retarded women’s progress in
this respect.
5 UNFINISHED AGENDA AND THE NEW CENTURY
As we see, the country and its development actors are left with a burden of
responsibility rather than a sense of fulfillment at this juncture. Looking from the
vantage of the people whose problems and sufferings elicited the global response
of the Copenhagen Summit, we see that most of the non-achievement can largely
be ascribed to a tendency of development administration to stand apart and away
from the people it serves. The unfinished agenda which the Copenhagen
commitments hold aloft, will forever be elusive but for a qualitative shift in this
tendency. Redefining the goals alongwith the concerned poor and vulnerable,
working out a functional partnership with the civil society organisations, PRIs and
organisation of the poor for resource use and development from local level
onwards, recognising them as equitable stakeholder and releasing tlieir initiatives
are the key processes of action which must needs to be begun to fulfil the
objectives of commitments early in the next century.
* Produced by Centre for Policy Research and Advocact, a Unit of CYSD, Orissa
in collaboration with Voluntary Action Network India (VANI), New Delhi
Institute) det Tercer Mundo- Social Watch
An NGO watchdog system aimed at monitoring the commitents made by govermments at
the World Summit for Social Development and the Beijing World Conference on Women
OUUUCU 1
hap://www.socwatch.org.uy/1999/cng/inlormcs_nacionalcs_99/gbr99cng hi
UNITED KINGDOM
MAKING PROGRESS... BUT NOT ENOUGH
Fran Bennett
Die new Labour ^erntneni ha^ identified poverty and social exclusion as kev
issues, and aeciared its intention to tackle their root causes in a
cross-departinental, iniexrated way. It is coivanitied to rnainstreanung gender
awareness, and bnprovine represeniaiion of women and ethnic minorities. Hui its
approach to social development is not couched in the iangua^e of social and
economic rights, or redistribution, blit of inclusion, opportunity and
respansiotiityti and the Copenhn-'en commitments are not used as reference
points. Critics nave accused it offading io challenge sufficiently the current
supply side and markei-oriemed orthodoxies, and of echoing the residualist
rhetoric about welfare common in the USA.
«We Commit Ourselves to creating an economic, political, social, cultural and
legal environment...»
The UK government has incorporated the European Convention on Human Rights
into British law, facilitating legal challenges on civil and political rights. But it is
more sceptical about the value of legislation guaranteeing social and economic
rights; and, although it has signed the Council of Europe's revised Social Charter,
it has refused to ratify the collective complaints procedure. In the area of children's
rights, however, the government has set up a group which includes NGOs to help
monitor progress on achieving the goals of the UN Convention on the Rights of
the Child.
The government has made progress towards devolution in Scotland, Wales and
Northern Ireland. Regional development agencies are also planned in England, bu
fairly tight financial control of local authorities is still maintained.
Power over resources for social regeneration may be devolved to some local
communities.- In some areas (especially crime), ministers tend to perceive the
views of NGOs as not reflecting the real concerns of local communities?
Proposed legal reforms to decision-making and appeals in social security and
asylum/immigration, and availability of legal aid, affect important policy areas for
disadvantaged groups. Although some changes are positive, others have been
criticised for sacrificing fairness and individual rights to speed; and measures to
tackle anti-social behaviour' are seen as draconian by some.
<■ VVe Commit ourselves to the goal of eradicating poverty in the worid...»
The Prime Minister says the government should be judged on whether it improves
the living standards of the poorest^ The government also highlights «social
exclusions seen as dynamic and multi-dimensional. It set up a social exclusion unit
in the Cabinet Office, which can take a cross-departmental approach. The unit is
tackling specific issues, and investigating indicators of social exclusion. But its
direct communication with people in poverty is rather unstructured; and outside
organisations are consulted, not involved as co-participants.
The government has not drawn up a national anti-poverty strategy with
1 of 5
7/1/99 1:54 PM
Untitlcdl
http://www.socwatch.org.uy/1999/eng/informes_nacionales_99/gbr99eng.hi
goals and targets. However, the Prime Minister describes government policies as
an anti-poverty strategy in action, which includes: cutting unemployment; tackling
low pay; getting benefits to people in need; education, to prevent future poverty;
regeneration of the poorest neighbourhoods; getting public services to people in
need; and bringing in new allies as partners^ He has promised an annual
progress report The government is also investigating the exclusion of
low-income people from financial services and the withdrawal of shops from poor
areas. But one commentator suggests between 350 thousand and 1.95 million
more people could be in poverty (on under half average income) by 2002,
depending on government policies and unemployment level£
Poverty has become more concentrated in small areas. Funds are being released
from local authority housing sales for reinvestment, and a series of area-based
programmes is targeted at disadvantaged neighbourhoods. But these areas often
have to compete with one another in bids for additional resources.
The government embarked on «welfare reform», widely interpreted as meaning
reductions in social security spending. Following opposition to benefit cuts for
lone parents, and protests about threatened cuts for disabled people, the
government is now proceeding more cautiously, with increases in benefits for
specific groups. But most benefits will probably increase only in line with prices,
not rising prosperity.
The government says tackling the root causes of poverty means focusing on
opportunities, especially education and employment. This approach has been
welcomed -but criticised for under-emphasising low income, and over-emphasising
paid work rather than unpaid caring.
The government has fulfilled its manifesto commitment to reverse the decline
in spending on overseas aid, and made encouraging statements on the need to
tackle the debt burden. Its creation of a separate department for international
development, and Cabinet status for the minister, moved international poverty up
the policy agenda. Its policy on development includes a clear focus on poverty,
which is consistent across departments.- But on trade and investment issues, it
could give more emphasis to the extent to which globalisation creates «losers»,
and to poverty as an issue to be tackled internationally.
«We commit ourselves to promoting the goal of full employment...»
A government aim is «full employment for the 21st century^ But the emphasis is
on employability and other supply side factors, not direct job creation; and the
Bank of England's control over interest rates is seen as prioritising controlling
inflation over reducing unemployment.
«New Deals» have been set up for young and long-term unemployed people, lone
parents and disabled people. They include temporary job subsidies, work
experience, education/training and personal advice. They have been broadly
welcomed, though critics point to the disproportionate share of resources for the
young unemployed, the one-off nature of the funding, and compulsion (with
potential loss of benefit) for young people.
There is concern about the low quality of «entry level» jobs for unemployed
people, who often do not progress to better employment;-- marginal jobs are not a
2 of 5
'll} /oo i -s-1 PM
Untitled 1
http ://ww\v.socwatch.org.uy/1999/cng/infonncs_nacionales_99/gbr99eng.h
route to social inclusion.— The government signed the European Social Chapter,
but has made clear it will not support all proposals for more regulation. Rights at
work, including union recognition and employment protection, are to be
improved.-1Another goal is to «make work pay». A statutory minimum wage will be
introduced, benefiting some 1.5 million workers-.-- But unions criticise its
inadequate level, and in particular the lower rate for young workers. There will
also be reductions in national insurance contributions for low-paid workers and
their employers.
«...To Promoting Social Integration by fostering societies lliat are stable, safe and
just...**
The government created a Race Relations Forum, to give ethnic minority
communities more direct access to it, and is consulting on anti-discrimination
action.
Asylum and immigration policy and practice are now less secretive. But the
government’s use of detention has been strongly criticised; and proposed
policy changes include abolishing asylum-seekers' rights to cash benefits and
choice over housing location, and curtailing appeal rights-.-- This is in line with
proposals for more restrictive policies towards refugees in the European Union as
a whole.
14 Turn-out rates
One in four ethnic minority electors has not registered to vote.-for black Africans and black Caribbcans in the general election were lower than for
other groups,-- reflecting political alienation. New measures give additional
powers to tackle racial incidents; but police treatment of black people is repeatedly
criticised.
The government inherited anti-discrimination disability legislation widely perceived
as ineffective. It is tightening up the provisions; but many disabled employees will
still be unprotected, due to small company exemptions.
«...To Promoting full respect for human dignity and to achieving equality and
equity...**
The government set up a «women's unit», which has now moved to the Cabinet
Office. A minister for women was appointed (mpaid). Mainstreaming of gender
issues was promised, but policy guidance to departments has not yet been
published. The government's priorities are child care, family-friendly employment
policies and violence against women. Women make up only 18% of MPs and 31%
of public appointments;— «quangos»^ are to have a target of 50% women.
Women still receive only half men’s average weekly income— Government
proposals would improve maternity provision, and introduce paternity and
parental/family leaved -although unpaid leave may have limited value. The UK
signed an EU directive improving part-timers' employment rights. Whilst the
government is making progress, the Equal Opportunities Commission has called
for a «super-law» to overhaul and update sex equality legislation.
3 of 5
7/1/99 1:54 PM
Untitlcdl
http://www.socwatch.org.uy/1999/eng/informcs_nacionales_99/gbr99eng.hi
«... Universal and Equitable access to quality education»
The government has put high priority on education, from nursery schools to higher
education. Primary schools must prioritise literacy and numeracy, and targets have
been set to cut truancy and school exclusions by a third by 2002^ Twenty-five
«education action zones» are being created in deprived areas to experiment with
different approaches. The government emphasises «life-long learning:*, and a
working group is to tackle poor basic skills among adults.
Proposals to finance a means-tested staying-on allowance for teenagers by
abolishing universal child benefit for this age-group are controversial. Tuition fees
are being introduced for higher education for the first time. Some commentators
say anti-poverty measures would be more effective for children from low-income
families than the current emphasis on raising «sUndards>^
«...To Promoting the highest attainable standard of physical and mental health...»
The government launched an inquiry into health inequalities. Other policy areas are
now recognised as influencing health status of the population. Twenty-six «health
action zones» are being created, to improve the health of the poorest. The social
exclusion unit will investigate teenage pregnancies, which are higher in poor areas.
The influence of the internal market in the health service is being reduced. Ethnic
minority groups' access to health care is being investigated. But fewer low-income
individuals visit doctors and dentists regularly than five years agaThe health divide between rich and poor has widened over recent years^ Many
commentators welcome the government's policies -but say there is still a long way
to go.
«We commit ourselves to an improved and strengthened framework for
International, Regional and Sub-regional co-operation.
The government has not publicised the Copenhagen commitments relating to
the UK, nor organised monitoring with outside organisations. Its
anti-poverty goals have not publicly been linked with the Social Development
Summit
Notes
1 R. Lister, address to conference on equality and the democratic state,
Vancouver, November 1998.
2 Social Exclusion Unit. 1998. Bringing Britain together: A national strategy for
neighbourhood renewal. The Stationery Office.
3 Eg, see article by Home Secretary. The Times, 8 April 1998.
4 Speech by Prime Minister. The Independent, 8 December 1997.
5 Speech by Prime Minister. 30 January 1998.
6 D. Piachaud. «The prospects for poverty». New Economy, spring 1998.
Blackwell Publishers Journals.
7 Department for International Development. 1998. White Paper, Eliminating
world poverty: A challenge for the 21st century . The Stationery Office.
8 The Chancellor. The Times. 29 September 1997.
9 M. White and J. Forth. 1998. Pathways through unemployment: The effects of a
Unt’Lledl
bttp://www.socwatch.org.uy/1999/eng/informes_nacionales_99/gbr99cng.h
flexible labour market. York Publishing Services Ltd. for the Joseph Rowntrce
Foundation.
10 T. Atkinson and J. Hills (eds.). 1998. Exclusion, employment and opportunity.
CASE Paper 4, London School of Economics.
11 Department of Trade and Industry. 1998. White Paper, Fairness at work. The
Stationery Office.
12 Institute for Fiscal Studies press release, 5 June 1998.
13 Home Office. 1998. White Paper, Fairer, faster and firmer: A modem
approach to immigration and asylum. The Stationery Office.
14 Research by M. Anwar. 1998. Commissioned by Operation Black Vote.
15 S. Saggar. 1998. Ethnic minorities and electoral politics. Commission for
Racial Equality.
16 Equality Indicators. 1997. Equal Opportunities Commission.
1 / «Quangos» are quasi-autonomous non-governmental organisations.
18 Income and Personal Finance. 1997. Equal Opportunities Commission.
19 Department for Trade and Industry. 1998. White Paper, Fairness at work. The
Stationery Office.
20 Social Exclusion Unit. 1998. Truancy and school exclusion. Cabinet Office.
21 P. Robinson. 1997. Literacy, numeracy and economic performance. London
School of Economics, 1997; I. Plewis. inequalities, targets and zones»,Vevv
Economy, 5(2), 1998.
22 National Consumer Council. 1998. Consumer concerns 1998: A consumer view
of the health services.
23 Office for National Statistics. 1997. Health inequalities: Decennial
supplement. The Stationery Office.
UK Coalition Against Poverty
************«**••«»
Instituto del Tercer Mundo- Social Watch
An NGO watchdog system aimed at monitoring the commitents made by govermments at
the World Summit for Social Development and the Beijing World Conference on Women
5 of 5
7/1/99 1:54 PM
Cor'i H M 3 • 3
Social Watch India 2000 and Beyond: A perspective
What Is S ocial Watch ?
•
It analyses social development policies, and actions by state / non-state actors in so far as
they {briber achievement of projected goals while bringing about equity.
.
Since 1
the Social Watch India has been generating a report on an annual basis analysing
social dflvdopment initiatives by mostly the govemment(s) and also the social dcvelopmen
situation This was basically circulated across different government departments, individual
citizens ^nd different NGOs across the country for public education and opinion building
•
The report was basically being prepared by CYSD and VAN!
. While the report is primarily oriented to sliarpen the advocacy agenda on equity issues, only
this yealfonwards there is a plan to link up advocacy activities on relevant points of analysis
in the rq|xxt.
.
While iti takes definite pro-poor / marginalised positions on social structural / governance
related ^equities, it takes an inclusive approach towards (possible) partnering actors.
.
It examines government action not in terms of programmes per se but also puts in
perspecdve the fundamental policy assumptions and ths context There is now an attempt to
elaboratly look at what is being done by CSO/NGOs (
•
It aimutW foster a mutually supportive and synergistic relationship between different
state/n<itH(tate actors involved
•
it is a .process of proactively putting up a constructive development agenda m light of the
innovative experiences/cxperiments on the ground.
Thematic i^nnmeworic
by gender, rural-urban differences and vuliHsrable groups
permit.
=-7> bJ^/T $lt-9O
BAslc Eniiiktment s
c
Learning i
•
access At literacy and basic education in keeping with the specific linguistic and cultural
•
, .
,
context]]
access tfo further educational opportuniti^,building upon local knowledge systems and
cultural! jethos at the primary', secondary and tertiary levels.
Staying healthy
•i
♦ access ^wholesome food and freedom from hunger/mal-m*riticn
• access ^hygienic and dignified shehen/
♦ access sanitation and potable water
• access W primary health care with emphasis on the aged, mothers and children^/
i
!
I
‘
06-10-1999 19:04
FROI1:CYSD BBSR INDIA
01 674 903726
TO:91 000 S525372
Smtataabto HvBUhw9
•
•
•
•
access t ui productive natural resources like forest, river, etc. of dependent communities /
opportunities to strengthen existing skill-base in a need-based and market oriented maimer
and acciii»s to market information and linkages
promoti^i of local enterprises in a market-oriented maimer
optimising access to sustainable employment opportuaiticw for the resource-marginalised
people •
•
examiniA the impact of modem production system, particularly industrialisation on
livelihoclij opportunities of affected people
•
‘ wages,, maternity benefits, and dignified and secure work environment
right of iiir
Particlp*ttynfartn*Mhip In governance
[i
•
•
•
•
FunctioniHL administrative and financial autonomy of PRIs
Dalits, tri mJs and women play folly and freely their roles in self governance!:s
Adequate legal / operational space for participation of broad-spectrum civil society
orgaisati.Mns in formulation and....
................
implementation of- public
policies and programmes at all
levels
.
Evolvinguibrms of collaboration between state and non-atate agencies and other civil society
organisatHhns.
Analysis art|l Indices
There is an aijiimpt to incorporate certain nuances in the analysts from thia year onward. While the
analysis will W qualitative to a great extent there will be an attempt to develop two types of indices
basing on boA qualitative and qualitative data The details rfcftkuhtfos will be finalised after
collection of 11 necessary dma The following considerationu wiM be used while constructing the
indices.
Two major af| (Xs oftte above tlwmes and sub-themes which the arudyais will need to focus on
are: a) what b||| been the-------achievement
_f to what extent, necessary w
b
--------- so
- far
— the
-—> respective
andw
— in
arm,r b)
desirable step! are being taken by the government and etiwr aril aoeieiy. maritotions towards
fulfilment of i||ter
L; "xt
***
* ‘ will bring
• out the
..............................
objectives.
The analysis
MuatiaMd details and perhaps indicate
the nature andiiMjections of further initiatives
In order to m|j|k out the social development situation and the adequacy (on lack of it) of action
taken precise!^ it is proposed tlsat the information be used to prepare indices in addition to
analytical intejtoretations Tlie first one could be a Social Devetopmmt Index, which can be
prepared out oflthe values of different indicators on the suggested themes / sub-themes. The second
one could be sti Adequacy of Action Taken Index prepared out of indicator of action taken on the
themes/issues. Ko«ne indicators on these two counts are ^iggested betow
IncHcator* fc|| Social Dsvatopnwnt tntlex
On Education, n in the domain of basic sei vices, some indicators eouW be gender-disaggregated
literacy rate in lerural / urban context, and across various population groups, gender disaggregated
data on eniolnj itfl and achievement at the primary, secondary and profiworwMiighet education
levels across v| mus caste pqmlation groups; outreach of schools/other educational institutions in
rural / urban / i;j ibal areas. Existence of syllabi/teaching teaming materials used in school based or
other educated programmes sensitive to the liveiihood/tadtwd needs of disadvantaged
commumties, tent of resource support (financial or otherwise) to students from poor and dalit
communities ai|| women amongst them.
On health, son* indicators could be gender-disaggiegaged data on recess to primary health /
reproductive hiflth care, sanrtMion and potable waler of SCZST/women and mmorities, gsnderdisaggregaged <|||ta on infant/child mortality, life expectancy, incidence of preventalde ifisesw
P:02
f
•: ■
'Ti
On housing, AoQess to pucca and hygienic housing and dtictridty^differ
groups, per Mita room ^ace across caste/population groups cttald be some indicators. On food
caste/population groups,
security, gertfw-disaggrc^aied nutrition status incidence of
spread of ffblic distribution system and off take tGross different socioeconomic groups,
consumptiorj | ems of mesi, women and children across different population groups, could be
some indicatj 1
j
In the doniai|| of sustainable livelihood the following indicators may be considered: Access of forest
dependent p<|| p|e to forest resources, status of land holding acKMS different GMtt^popuiation groups,
* disburaemem of the scheduled banks and other financial institutions, performance
profile of cnit lit
of other craji| t programs targeted at the poor, perfonnance of AilVeatrepreneurship promotion
programmeaji employment ratee across caste^populatiofl groups and women. Retraining /
redeployment/ compensation schemes and their oper^km in the ftce of job loas/redundancy etc,
1profile of I xrss to employmem generated, status of unplementstfon of measures on equal
remuneration fiiir wages, maternity benefits, protection again* GCtttpetfonal hazards, and pattern of
displacemenijl usd rehabilitation.
.1! i
In the dnmaii of part
participation and governance th® following indtCWtom may be oonaiderod: number
of PRIs undi (takingj local planning, PRIs preparing their budget* and irnplementing them, PRIs
accessing fill mrial iresource, existence of legal proviakxu for fenctfonal / financial autonomy,
indige
percentage c|| indigenous
people / women attending / actually participating in decision making
processes, eiwin of participation of women / indigenous people in orientation / capacity building
lumber of public policies
GCBSukattott with CSOs at any level.
policies, which include coesutomon
programmes.,! laimber
;l
.III
In the domaii of gender sensitivity some indicators codd be the following: incidence of violence /
abuse againsj women and gsrl children, percentage of women at dificrent levels of bureaucracy,
judiciary and|j n the state legislatures / parliament, corporate tesdsship, remuneration gap, status of
inheritance, c|j /worship rights, safe and friendly work environrasnts
Vc‘l
Indicator* # ActionTakan
■’I
J
While considniMg the adequacy of action taken on any thetne/sub-tbeme the following aspects need
to be consideifedr
Existij
and implementation of policies / laws / gpveroiwt reeakstkrns / orders enabling
the achievement of stated objective
Funct
Used / practicable / time bound plan of action
Adeqliittu allocation and utilisation of resources(human/financisl) and infrastructure with
appro! iiete
iilte provisions for devolution
Non-(| sqriminatory imptementation (with respect to gender, casta/cksfi, ethnic and minority
group))
.................................
_ ' ’ .
_ _
Bxten|| <"
.
with civil society institutions and’ o^Htisations
of the target
of collabcsatioQ
groups
in fon|| ulation and implementation of programmes
Exten|| of operatonaliution of programmes for capacity building of CSOa^CBOs etc. for
abovejt e^nti
itioned participation
AvaiLj tittyj of relevant gender-disaggregated uaformatfon base or plans to generate such
infomji ntfcn base
Existc|| oe of appropriate provisions to didt women’s p^tidpation at all levels
1
i
]
n'l H
NATIONAL HEALTHWATCH MEETING
NEW DELHI, 18-19 JANUARY 1999
Summary of presentations as presented in the concluding session.
The backdrop:
HealthWatch is a network of field based voluntary organisations, researchers, women’s health
advocates and social activists who are concerned about issues surrounding women’s health. This
group informally came together prior to ICPD Cairo and has since then expanded to include
organisations and individuals who are committed to promoting an a holistic approach to health,
population and development. The members who are part of this informal network can be
categorised as follows:
1.
2.
3.
4.
5.
Grassroots voluntary organisation working among the people on issues ranging from
women’s empowerment, primary health care and child health. For example: VGKK of
Mysore, SEWA of Gujarat, CINI of West Bengal, Sahaj - Sarathi of Gujarat, Sahyog of
Almora.
Organisations with a national character working in the area of health research and advocacy
for voluntary family planning and engaged in implanting their own projects and programmes
of the Government. Voluntary Health Association of India, Family Planning Association of
India.
Voluntary organisations engaged in training, research, material production, and advocacy.
For example: CHETNA of Gujarat, CEHAT of Maharashtra, Centre for Advocacy and
Research, SOCTEC, Mumbai and IWID of Chennai.
Research and teaching institutions with a mandate to work in the area of health, population
and development and related fields. For example Indian Institute of Management, Bangalore,
IIHMR Jaipur, IPAS Mumbai, FRHS Ahmedabad.
Social activists, researchers, trainers and other professionals involved in this field - who may
or may not be affiliated to any organisation.
In 1996-97 HealthWatch network organised regional meetings across the country on the newly
adopted Target Free Approach of the Government. These meetings were co-ordinated by
different organisations. The findings of these regional thematic meetings were shared in a
National Meeting in April 1997. It is now almost one and a half years since the first round of
regional consultations. In September 1998 the Steering Committee of HealthWatch (consisting of
17 persons from almost all regions of the country) decided to conduct small qualitative studies in
two Districts each in ten States to gather information on the implementation of the TFA (now
called Community Needs Assessment Approach) and the RCH programme of the Government.
Dr. Leela Visaria prepared a format to gather information through focus group discussions,
interviews and review of data at the District level. She had already done the exercise in Rajasthan
and Tamil Nadu. Seven HealthWatch members volunteered to do the study during the months of
November and December 1998. This meeting was convened to share the findings of these
studies. The following organisations / individuals presented the studies:
1.
2.
3.
Andhra Pradesh: Dr. M Prakashamma of Academy of Nursing Studies, Hyderabad.
Haryana: Ms Kiran Kalway of Family Planning Association of India, Yamuna Nagar.
Karnataka: Dr. H Sudarshan of VGKK, Mysore, Dr. Gita Sen and Ms
Anita Gurumurthy of I IM Bangalore
4.
5.
6.
7.
8.
Madhya Pradesh: Dr. C Vijayendra of Family Planning Association of India, Jabalpur.
Rajasthan: Dr. Leela Visaria. New Delhi
Tamil Nadu: Dr. Leela Visaria, New Delhi
Uttar Pradesh: Jashodhara Dasgupta of Sahyog, Almora
West Bengal: Mr Shekar Chatterji and Dr. K Pappu of CINI, 24 Parganas.
[Gujarat: Ms Mirai Chatterji of SEWA did the study but could not come for the meeting.]
In addition to the seven studies presented, HealthWatch reviewed recent documents on the
RCH programme of the Government. This initiative was co-ordinated by Dr. Prakashamma.
Dr. Radhika Ramasubban convened a Media Advocacy meeting and presented the
recommendations of that group.
The good news:
•
Government of India has sent directives to all the states and does not fix any central targets.
•
Government of India has advised all the States to organise six-day orientation training on
RCH approach.
•
The level of awareness across the board is much greater that what it was in 1997. Field
workers like ANMs were aware of TFA, RCH and also about the new CNA approach.
•
The impact of the six-day RCH training done in many states has been positive.
•
Sense of relief among ANMs over the elimination of competition on targets with non-health
personnel.
•
District RCH and IPD projects are being formulated in many States.
•
Some innovations with promise:
•
Tamil Nadu has initiated a very effective system to streamline the supply of drugs to PHCs and this is a replicable model. 7 Tamil Nadu had linked admission to post-graduate medical
education to three rural services by giving priority to those who have worked in rural areas.
•
Again, Tamil Nadu has recently mobilised private sector for infrastructure development of
PHCs and Sub-Centres. 7 The integrated RCH approach has led to improvement in the
rapport between ANMs and women - in Karnataka, Andhra Pradesh and Tamil Nadu. ANMs
no longer seen only as target hunters.
The disturbing news:
•
There is tremendous variation in the level of understanding across states and also across
levels - i.e. State level officials, Training Institutions, Medical Officers to ANMs.
•
Not all State Government officials are convinced about the new approach.
•
Political leadership in many States continues to believe in the old approach.
•
There are many misconceptions - like “old wine in new bottle”, no real change we still have to
focus on sterilisation as the principle method of fertility control 7 Medical Officers, in
particular, seem to have been bypassed by training and orientation workshops.
•
The new approach implies a significant increase in the workload of ANMs, while the Male
Multipurpose Workers have escaped yet again. 7 Policy documents and RCH projects silent
on the role of Traditional Birth Attendants - as a result there is little discussion on the role of
TBAs in improving maternal health, and also motivating couples to space children and use
contraceptives.
•
Male involvement is still a neglected area.
•
Record keeping continues to get priority - with a great deal of time in training and in the day
to day work of service providers devoted to it.
•
Safe abortion is yet to be addressed - only the Districts taken up under the UNFPA assisted
IPD projects have included management of complications arising out of unsafe abortion as a
priority area.
Targets and incentives - have they gone?
•
Again there is tremendous variation across the country, and studies recorded different
perceptions.
•
In some states terminal method of contraception continues to be the mainstay of the
programme - with the exception of Tamil Nadu where it was reported that people are so
motivated that they come automatically. 7 In some states incentives to sterilisation acceptors
continue. Andhra Pradesh takes the cake! The private sector has been mobilised to provide
gold chains and other material incentives to sterilisation acceptors. 7 The political leadership
across the country is still talking about targets and incentives. This is also true for senior civil
servants and corporate heads.
Who is fixing the target?
• Mixed picture emerged
•
In some States it is fixed at the District level, in others it is done one the basis of computer
data base, in others it is decided on the basis on ANMs reports with the help of LHVs, and in
some ANMs send their targets and it is revised by Medical officers.
Is quality of care and client centred approach a priority?
•
No significant change in service environment in most States.
•
There is not much evidence to show any marked improvement in service providers’ attitude
towards clients.
•
The community is still looking at quality as regular and reliable availability of services.
•
Quality of care, even in static centre based sterilisation camps have not improved - women
are still treated carelessly. Even where the technical quality indicators have been adhered to,
there is still no change in service environment.
•
Counselling is equated with motivation - thereby negating the importance of dispassionate
counselling on spacing methods vis-‘-vis terminal method.
Some area of concern:
•
As it stands today, Government of India has given the option of withdrawing incentives and
channelling those funds to improve quality to the States. Can the GOI play a more proactive
role in discontinuing incentives?
•
Availability of trained persons to conduct deliveries is linked to the safety of ANMs. In most of
the States the percentage of Institutional deliveries is extremely low (for example in
Rajasthan it is only 23 per cent). Inability of ANMs to move with a sense of security hampers
their ability to attend deliveries. This issue is linked to the importance of empowering ANMs
and enabling them to build a rapport with the community and other women workers in their
area. While universal access to institutional deliveries may be the goal - we still have a long
way to go before other regions catch up with Kerala and Tamil Nadu. 7 Maternal mortality
and morbidity continues to be a area of concern - and given the prevalent situation in most
parts of the country, TBA continue to be the first line of care givers. Training them and
improving their ability to identify complications and referring them in time to the nearest Sub
Centre, PHC or District Hospital is important. Therefore, we cannot afford to ignore the
training needs of these care providers.
•
There are a bit too many training programmes underway - and in many districts ANMs were
running from one programme to another. Rationalisation and integration of in-service training
is necessary. 7 The Panchayat representatives do not seem to have been involved in the
new programme. Given their proximity to the people - involving them and giving PRIs a
mandate to work in this area is acknowledged - but little has been done in this direction. In
view of the fact there is very little community mobilisation for RCH - PRIs could play a crucial
role in influencing the health seeking behaviour of people. 7 ANMs are being informed about
RTIs and STIs - but there is still no mechanism to provide medical care to women (and men)
suffering from these ailments. Some studies revealed that people still go to private doctors /
RMPs / Quacks for STD. But women suffering from RTIs and STIs still suffer in silence.
•
In many areas - i.e. Haryana, Madhya Pradesh, Rajasthan and Uttar Pradesh -client
interviews revealed that there is no perceptible change in the picture on the ground. Targets
may have gone and non-health personnel no longer chase people, but the fact remains there
that there is little evidence of any other change.
•
In view of the fact that a lot of external funds are being pumped into the RCH programme the long-term sustainability of this programme needs to be debated.
•
While Government of India documents discusses the importance of involving NGOs in the
RCH programme, GO-NGO relationship is still tenuous. There should be greater
transparency about new schemes / programmes.
•
The Mother-NGO concept needs a careful look. Mother NGOs present in the meeting asked
for a debate on the concept of mother NGOs.
Orl H M8G
I
BHARAT JHUHJHUNWALA
D1/31/XV Rohini ' Post.Box 10754
Delhi 110 085
Tel: 729-8589/789-3673 f Fax: 729-0635/708-1935
email: bhahatjSrida.vsn1.net.in
AN ALTERNATIVE VIEWPOINT ON
GLOBAL HEALTH WATCH ■
to the GHW
difficult task of responding
You have given me a
proposal. I have many questions but Ia will try to put down <ny
basic response as simply as I can.
1
The Roles'of the 'Intellectual* and the * Organization *
It seems to me that many of the impacts of the various 'Watch'
Brown
I
Lester
the realm of ideas.' The Work of
has been in
ideas not
for
(Overview:!)
is
example,
the impact of
impact of
organization. To make it clear, let us examine the
the works of Darwin or Marx. The impact has been
much greater
that what any NGO can claim to.have made. ;’
•
.
. • •• •
honours
such
as Nobel
There is a danger of relying on. the
Prize as well (Overview:!, reg Rugwash). My impression is that
such honours are reserved for people following a.certain world
view which is amenable to the dominant Western viewpoint.
■
■
■■
■■
■'.
■■■■
•
■
-
i'-
’
•
1.. •
.
.
The point is that the real • and * vested—in terest—free* impact
can come from ideas.' It does not require an organization, NGO
narrow
or otherwise,
Organizations often develop their own
vested interests.
unique
feel that many
I
of the
* NGD networks which
have
in
the
(Draft 2:2)
are in fact a fifth column
capacity'
developing countries. Funded by foreign money they have little
roots in the body politic of their own countries.
i s significant that there is no 'Indian* concept of an NGD. .
It is
We have the concept of an 'ashram* and *vanaprastha*. The NGOs
to take their inspiration from the Christian ethic of
appear
arises when
loving the neighbour. This is fine. The problem
if a person
'love* becomes organized. ' It is acceptable
this
his own bread
was earning
by running a shop or whatever and
then he loved others
by giving away part of his well
earned
income. But that is not what NGOs do at all. They
earn their
'serving*. It
then becomes difficult
breads by
to ascertain
whether the 'loving is a facade for bread winning' or 'loving
is the high altar on which income, has been sacrificed'.
that more often thani not, the service
I find
ethic has been
to
turned around
sustain the vested \ interest
of
the NGO
bureaucracies- These
the
Western
bureaucracies support
political interests by which they are well
fed and sustained.
This is my criticism of WHO, UNDP and Human Rights Watch, two
of the parallel institutions which find high mention in your
notes.
My considered view is that these institutions are
taking us in
the wrong path of welfarism
(see following
section).
The Indian tradition of love insists that it is an individual
affair.
loving
There is a fundamental difference between
another as an individual
with his own well earned
income
(Indian tradition);
an
and
loving another by building
organization which is also the basis of
one's economic
sustenance (Christian-NGOI tradition). The former is okay. It
has no vested interest, The latter is highly questionable. One
does not know whether the 'service' is a facade for operating
as a fifth column; or it is genuine sacrifice.
In other words, I
am questioning whether the objective of
can be served by building an organization at all. An
'loving'
organization inevitably smacks of
'political'
aspirations—
power in one form or the other. It becomes worse when advocacy
'to work/fight'
and
is explicitly accepted as an objective
(0verview:2).
What does advocacy built on foreign money mean? To me it means
that
governments working
foreign donors, often
through
churches and the UN system, will tell the Government of India
to behave itself. If Government of India does not behave then
it will
'international community' —read
be hauled up before
Western powers. Is that not a fifth column?
The point I am making is like this:
1
'Love' and 'Service' make sense only when undertaken from
self earned income. They cannot be made vehicles of earning
one's own bread
as NGOs, including the proposed GHW,
seek to
'Organized' social
do.
politics, not
service is essentially
love.
Political activity—advocacy and fighting,
2
as the NGOs
and GHW inherently are, should be done within national domain
with strictly national money. There in no locus standi for GHW
to advocate.
3
NGOs and GHW would be acceptable only if
they provide a
platform for brainstorming and
think tank to such individuals
who might be serving and loving with their own incomes.
The existing WHO, UNDP and Human Rights Watch are engaged
4
in fifth column intellectual activities.
2
Welfare State
The documents sent by you emphasize
the aspects of
equity
(redistribution of
income) and
to health
access or 'rights'
(Draft 2:1; Draft 3:2-3).
This approach is premised on
the
are powerless vegetables who cannot
belief that people
themselves earn and secure good health. The emphasis shifts
from increasing incomes to increasing rights 5 access, feeding.
giving or charity.
fundamental economic'conf 1ict in the world today,
There is a
; want unequal exchange to continue. They
Western
powers
The ’
countries should continue to sell
that thedeveloping
<want
textiles,
ores,
etc); and
cheap (tea,
9
technologies
their manufactures
fpchnoloaies,
, etc.)*
goods (financial services
import hi—tech
* j being sold to the developing world in
This unequal exchange is
flows, free trade and
international
capital
the name of
--- —
globalization.
exchange is the
this unequal
One of
the consequences of
while
the developed
developing countries are getting poorer
The West wants to preserve this economic
countries get richer,
order.
unrest in the
--j
that there -i is increasing
Another consequence
etc
poverty
due to increasing
;---developing countries
<----this unrest to
the West is to contain I destroy this
of
The objective
levels lest it spill over and. to health is a
'manageable'
equity and access
unequal exchange, The talk of
containment
strategy.
part of this <--
liberate the people of the developing
The objective is not to
just enough relief that they do not
ensure
but
to
the existing
countries
at
exchange and rebel
the unequal
understand
world order•
' risk
this
instrument of
important
The
an
NGOs are
by the West to ensure that
given
money
management'. They are
safety nets
Thus the talk of
discontent does not spill over.
(Draft
3:2),, etc.
pproach
systemi a
the
incomes
economic
(Draft 2:1) district health
These approaches do not seek to increase
on
health
I
their
that they can acquire good
of the people so
make
to
they
seek
them
own seif-respectedly earned incomes;
government (and World Bank and
intellectually dependent on the < self-esteem and make
them
their
kill
foreign donors),
they
are
question
why
dependent upon doles so that they never
poor in the first place.
instrument in this
--- > to be yet another
GHW appears
instrument to
The proposed
|
It may bo yet snother
the unequal
' risk management'.
task of
resisting
distract us from the basic
economically stronger.
exchange and becoming
the first para of Draft
urarc 2 was
■ ‘
This
It is important to note■ that
has been
; and globalization.
i
strong on trade policies
That is but to be expected. The
diluted in Draft 3.
globalization and
they will not
votaries of
NGOs are all
I of economic supremacy of
tolerate any fundamental questioning
of WHO, UNDP and the
theme
That is a consistent
the West.
like this
on
is entirely silent
Draft 3
of
inner
content
The
aspect.
3
Culture
It has become fashionable .to salute
'different cultural
(Draft 3:2).
beliefs'
But, this salute is circumscribed by
certain 'unquestioned' values. For example: (1) Gender equity
by making
the woman work in addition to her role as species
Women must be made additional
propagator.
economic inputs
(although their house work must be 'economically valued'; (2)
but not
Equity must be ensured within the developing world
between the industrial and developing world; (3) Democracy is
okay within the industrial countries but not at the world
level. Here it is the money-weighted vote that counts as in
the Bretton Woods institutions like World Bank or the Security
Council.
This talk of culture is hollow.
This problem cannot be sorted out without examining the very
purpose of life.
For the West it is increased consumption,
'wilderness' andI 'tigers—preserved —for—man-to-gapealbeit of
at'. Within this paradigm they will accept local
culture. If
you want to consume temples 9 that is okay.
Indian
tradition
the purpose is
For
evolution of
the
is so
individual
to his higher potential. If the purpose
the woman
it is no longer certain whether making
specified
work will lead to her evolution or devolution- Even, increased
consumption by the poor, if fed by the welfare state, may be
devolution. These questions appear to be out—of—bounds in the
documents circulated.
The point I am making is that the documents are fundamentally
based on consumption-as-objective and the role of the state in
ensuring consumption.
They do not permit questioning of this
to apparently
objective.
If this objective is questioned,9
obvious sanctity to gender justice
and equity may well
evaporate into thin air.
4
Conclusion
am not enthused about GHW. .1 see it as a perpetuation of
I
unequal global economy, I see it as yet another instrument to
like
countries
keep
intellectual
perpetual
India in
subservience.
see it as a result of 'organized love or
I
service', which is a contradiction and a smokescreen for fifth
column activities.
I think the only positive role that such organizations
can
perform is to provide a forum for Davos—type exchange for
dissenting voices. There is nothing more that can be done.
Objectives
The basic objectives of “HealthWatch” are:
I To translate the ICPD Programme of
Action for the national context by defining
priorities for public policies and action, and
the mechanisms for their implementation;
2 i To engage in a process of constructive
but critical dialogue with the government at
multiple levels; and to lobby for a shift in
the government’s Family Welfare
Programmes from provider-driven to
people-based programmes;
vi
To explore mechanisms to link repro
ductive health services to strengthen
public and primary health care, and related
aspects of development, especially educa
tion and women’s economic, political and
social empowerment; in particular to advo
cate restructuring government programmes
based on the vibrant NGO experiences in
this area;
i
To provide a forum for effective
networking among like-minded NGO’s to
make progress on the above objectives;
5i
To provide a forum for continuous
exchange of information and sharing of
ideas and experiences among NGOs them
selves.
For further information or any comments
and suggestions, please write to:
HealthWatch
C/o Gujarat Institute of
Development Research
Near Gota Char Rasta
Gota 382 481, Ahmedabad (India)
Phone : 079-474809-10
Fax : 079-474811
I
H
a
HealthWatch,
a Network for Action and Research
on Women’s Health
At a meeting of NGO s, held in Ahmedabad
on December 1-2, 1994, it was decided to
form a network to explore the feasible
approaches to move forward from the
Programme of Action adopted
at the International
Conference on Population and
Development (ICPD) in Cairo
in September 1994. We
visualized “HealthWatch” as
a vehicle to increase the
attention paid to women's
health needs and concerns ,
in public debate and
|
national policy. In fact, a |
|
series of meetings and
workshops which had
’
begun during the
preparations for ICPD
focussed on defining and
clarifying women’s health
issues, particularly
reproductive health and
rights, had prepared the
basis on which like-minded
NGOs can work together,
and begin a process of
constructive dialogue with
the government on policy
and programme directions.
background
Our Constitution guarantees each citizen
the right to life which includes effective
provision for work, food security; protecting
access of poor people to resources such as
land, forests, and water; safe, green, pollu
tion-free environment; safe drinking water
and adequate sanitation; adequate shelter
and the right to health. The state must
allocate adequate resources and design
supportive policies to provide these basic
needs to all people.
T ILIr1
-
£
itS
il?
><
The Constitution also
guarantees non-discrimi
nation on the grounds of
sex; yet biases against
women are rampant in
every aspect and
stratum of society. It
is therefore the
responsibility of the
state, as articulated
in the Directive
Principles, to
undertake strong
measures to remove
all forms of discrimi
nation against women,
and protect their
human rights.
In our country,
women’s ill-health is
mainly caused by
poverty,
gender d
be the ba
However,
ceived ad
resources
programm
to be cha
The inter
debates t
the conte
provide a
take-off p
such a tr
The ICPD
Programm
Action wh
agreed to
by India,
the large
other cou
central im
women’s
health an
women’s
and to th
of creatin
policy en
condition
and pres
This is th
which “H
formed.
PHCLAR AT1ON OF ALMA-ATA
DECLARATION OF
ALMA-ATA
The International Conference on Primary Health Care, meeting in Alma-Ata this
twelfth day of September in the year Nineteen hundred and seventy-eight,
expressing the need for urgent action by all governments, all health and
development workers, and the world community to protect and promote the health
of all the people of the world, hereby makes the following Declaration:
I
The Conference strongly reaffirms that health, which is a state of complete physical,
mental and social well being, and not merely the absence of disease or infirmity, is a
fundamental human right and that the attainment of the highest possible level of health is a
most important world-wide social goal whose realization requires the action of many other
social and economic sectors in addition to the health sector.
II
The existing gross inequality in the health status of the people particularly between
developed and developing countries as well as within countries is politically, socially and
economically unacceptable and is, therefore, of common concern to all countries.
III
Economic and social development, based on a New International Economic Order, is of
basic importance to the fullest attainment of health for all and to the reduction of the gap
between the health status of the developing and developed countries. The promotion and
protection of the health of the people is essential to sustained economic and social
development and contributes to a better quality of life and to world peace.
IV
The people have the right and duty to participate individually and collectively in the
planning and implementation of their healthcare.
V
1 of 3
8/17/99 3:48 PM
Governments have a responsibility for the health of their people which can be fulfilled
only by the provision of adequate health and social measures. A main social target of
governments, international organizations and the whole world community in the coming
decades should be the attainment by all peoples of the world by the year 2000 of a level of
health that will permit them to lead a socially and economically productive life. Primary
health care is the key to attaining this target as part of development in the spirit of social
justice.
VI
Primary health care is essential health care based on practical, scientifically sound and
socially acceptable methods and technology made universally accessible to individuals and
families in the community through their full participation and at a cost that the community
and country can afford to maintain at every stage of their development in the spirit of
self-reliance and self-determination. It forms an integral part both of the country’s health
system, of which it is the central function and main focus, and of the overall social and
economic development of the community. It is the first level of contact of individuals, the
family and community with the national health System bringing health care as close as
possible to where people live and work, and constitutes the first element of a continuing
health care process.
VII
Primary health care:
reflects and evolves from the economic conditions and socio-cultural and political
1.
characteristics of the country and its communities and is based on the application of the
relevant results of social, biomedical and health services research and public health
experience;
2.
"
iaddresses
the main health problems in the community, providing promotive,
preventive, curative and rehabilitativeservices accordingly;
includes at least: education concerning prevailing health problems and the methods of
3.
preventing and controlling them; promotion of food supply and proper nutrition; an
adequate supply of safe water and basic sanitation; maternal and child health care, including
family planning; immunization against the major infectious diseases; prevention and control
of locally endemic diseases; appropriate treatment of common diseases and injuries; and
provision of essential drugs;
i..................................4.
involves, in addition to the health sector, all related sectors and aspects of national
and community development, in particular agriculture, animal husbandry, food, industry,
education, housing, public works, communications and other sectors; and demands the
coordinated efforts of all those sectors;
5.
requires and promotes maximum community and individual self reliance and
participation in the planning, organization, operation and control of primary health care,
making fullest use of local, national and other available resources; and to this eiid develops
through appropriate education the ability of communities to participate;
of 3
8/17/99 3:48 PM
6.
should be sustained by integrated, functional and mutually supportive referral
systems, leading to the progressive improvement of comprehensive health care for all, and
giving priority to those most in need;
7.
relies, at local and referral levels, on health workers, including physicians, nurses,
midwives, auxiliaries and community workers as applicable, as well as traditional
practitioners as needed, suitably trained socially and technically to work as a health team
and to respond to the expressed health needs of the community.
vni
All governments should formulate national policies, strategies and plans of action to
launch and sustain primary health care as part of a comprehensive national health system and
in coordination with other sectors. To this end, it will be necessary to exercise political will,
to mobilize the country’s resources and to use available external resources rationally.
IX
All countries should cooperate in a spirit of partnership and service to ensure primary
health care for all people since the attainment of health by people in any one country directly
concerns and benefits every other country. In this context the joint WHO/UNICEF report on
primary health care constitutes a solid basis for the further development and operation of
primary health care throughout the world.
x
An acceptable level of health for all the people of the world by the year 2000 can be attained
through a fuller and better use of the world’s resources, a considerable part of which is now
spent on armaments and military conflicts. A genuine policy of independence, peace, detente
and disarmament could and should release additional resources that could well be devoted
to peaceful aims and in particular to the acceleration of social and economic development of
which primary- health care,, as an essential part, should be allotted its proper share.
*
*
*
The International Conference on Primary Health Care calls for urgent and effective
national and international action to develop and implement primary health care throughout
the world and particularly in developing countries in a spirit of technical cooperation and in
keeping with a New International Economic Order. It urges governments, WHO and
UNICEF, and other international organizations, as well as multilateral and bilateral agencies,
non-governmental organizations, funding agencies, all health workers and the whole world
community to support national and international commitment to primary health care and to
channel increased technical and financial support to it, particularly in developing countries.
The Conference calls on all the aforementioned to collaborate in introducing, developing and
maintainingprimary health care in accordance with the spirit and content of this Declaration.
►
of 3
8/17/99 3:48 PM
]
iii. Research and advocacy groups can provide
‘valid’ data from their studies especially
community based and policy oriented.
iv. Professionals and professional associations can contribute technical expertise
especially in analysis and interpretation. A multidisciplinary approach and a strong
public health orientation are necessary.
v. Consumer groups and associations can provide data and support lobby / advocacy
with the ‘health watch’ findings.
vi. Other watches can share their health related data to reduce duplication of efforts.
vii. Regional networks of NGOs and International health agencies could provide access to
their data bases especially from their partner agencies at the community / local /
national levels.
viii. WHO and its regional offices could support with regular monitored data from
member countries and data from special surveys, research projects and programme
monitoring system.
An effective ‘Health Watch’ will need to be able to access all these resources without
getting controlled by one group - so that authenticity, accountability and objectivity are
maintained.
4. fiHOW’ could such a watch function
The credibility and authenticity of the watch is crucial and its accountability ‘to watch on
behalf of the poor and disadvantaged’ who are most affected by the processes and trends
being watched.
An effective ‘watch’ will therefore have to be a combination of all these features.
Grassroots networks and citizens initiatives should be central.
Information collated and analysed should be credible.
-
The ‘rigorous’ research approach must be balanced with committed
dissemination and advocacy.
-
Local/national NGOs especially from the South must be actively involved and in the
lead, for it to be representative of a global democratic initiative.
information
- Its functioning should be flexible and responsive to emerging needs and concerns and
interactive with a large group of resource networks.
-
There must be a large component of participation by volunteers.
-
Data and reports must be effectively and widely disseminated to reach all those who
could participate in responsive action.
-
Inspite of its ‘activist’ concerns, the watch should be highly professional so that the
‘counter expertise’ generated is very evidence based.
4
5. Some unanswered questions
While the Health Watch’ concept has been receiving increasing and enthusiastic support,
there are some unanswered questions:
♦
How will the data collected or disseminated by the ‘watch’ reach the people, the
community, the citizens groups — particularly the poorest communities who could
be empowered with this information to understand their situation and fight for their
rights?
♦
How could such an initiative be prevented from becoming another north-dominated
and international NGO-dominated structure, providing solutions and top down
prescriptions to the governments and communities of the South in a condescending
or charitable way? How could the initiative be a truly democratic global process?
♦
How could such a initiative keep its independence and objectivity and credibility
and not become subservient to the conditionalities of funding partners or
international agencies including WHO, who will contribute to it but also be
watched by it? How could the global health watch be a truly independent
Global Health Ombudsman?
Those who help to initiate and develop the watch will have to face these questions in the
days ahead.
6. Challenges ahead
The challenges of contributing / participating in the evolution of a Global Health Watch
are many:
It could be a strong commitment to building a truly equitous and ethical global society
and a healthy one
It could be a significant example of north-south solidarity
It could be an opportunity to relook globally and locally at our life styles; our values;
our societal relationships
Finally, it could be an opportunity for professionals to commit themselves with
courage to standing up for the poor and the marginalised and to making Health a reality
for all.
ARE WE READY FOR THIS CHALLENGE??
References
1. • Haines, Andrew et al (1993)
Global Health Watch : monitoring impacts of environmental change
The Lancet, Vol. 342, Dec 1 1, 1993, p 1464-1469
2. World Health Organisation, (1997)
A new Global Health Policy for the Twenty first century ; An NGO perspective.
Report of a formal consultation with NGOs held at WHO, Geneva, 2/3 May, 1997.
3. NGO Forum for Health (1997)
Concept paper for the Global Health Watch
(several stage dra fts over the period), Sept 97 - May 1998, NGO Forum for Health, Geneva.
5
NOTE
All those who would like to respond to these reflections and participate in the
process of actually evolving such a ‘Watch initiative’ are requested to :
♦ Send their comments/suggestions to Dr. Eric Ram, Chairman, NGO
Forum for Health, World Vision International, 6 Chemin de la Tourelle,
1209 Geneva, Switzerland.
Tel :+41 (22) 798 41 83
Fax : +41 (22) 798 65 47
Email : wvi.gva@iprolink,ch
A project feasibility proposal has already been circulated by the Forum.
Interactive dialogue would help the initiative ‘get on track’.
♦ A copy of the above marked to the author would be an opportunity for a
continued interactive dialogue as well.
Dr. Ravi Narayan,
Society for Community Health Awareness, Research and Action,
No.367, ‘Srinivasa Nilaya’, Jakkasandra I Main,
I Block, Koramangala, Bangalore - 560 034, India.
Tel : 91 - 80-553 15 18 AND 91 - 80 - 552 53 72
Fax : 91 - 80 - 553 33 58 (mark Attn. Dr. Ravi Narayan, CIIC)
Email : sochara@blr.vsnl.net.in
6
C® ha
p
Q In X/l
COMMUNITY health
cell
Phone
Fax
Email
y- i
g-%
5531518 / 5525372
(080) 5525372
sochara@vsnl.com
No. 367, ‘Srinivasa Nilaya’, Jakkasandra, 1st Main, 1st Block, Koramangala, Bangalore - 560 034.
Communication Two
24th September 1999
Dear
Reg: Global Health Watch (National Meeting : India)
Further to our invitation to you dated 9th September with enclosures, we have noted the
confirmation of your participation and welcome you to the National Dialogue on Global Health
Watch.
Enclosed are the following:
(i)
A registration form to be filled in and sent to us as soon as possible (to reach us not later
than 3rd October, 1999;
(ii)
An extract from the WHO-NGO Policy Consultation in 1997 when the GHW with equity
focus was developed;
(iii)
An overview of NGO initiatives on Watches' all over the world. Though the compilation
from WHO is strong on 'Northern Watches', we hope through this meeting to enhance the
information of'Southern Watches' as well.
(iv)
We await the questionnaire sent to you earlier. Due to oversight, page 6 which was
corrected was sent without modification. A replacement of this page is enclosed.
Do send us the questionnaire and registration form to reach us not later than 3rd October, 1999.
The questionnaire is really a stimulus to think about the idea. There may be sections you do
not wish to fill. There may be ideas you have that are not included. Please complete as
much as you feel is relevant and send as soon as possible so that we can compile the responses
and enhance the interactive / participatory nature of the meeting.
Looking forward to your participation,
With best wishes,
Yours sincerely,
Dr. Ravi Narayan.
Enclosures : as above
PS: You can use fax No. (080) 552 53 72 or Email : sochara@vsnLcom to speed up the
process.
Society for Community Health Awareness, Research and Action
Registered under the Karnataka Societies Registration Act 17 of 1960, S. No. 44/91-92
Registered Office: No. 326, Sth Main, 1st Block, Koramangala, Bangalore - 560 034.
GLOBAL HEALTH WATCH (National Meeting : India)
Date : 7th / Sth October 1999
Venue : Ashirvad, No. 30, Off St. Mark's Road, Bangalore 560 001.
Registration Form
1. Name
2. Academic / Work Background
(Mention Discipline and focus of experience)
3. Organisation Represented
4. Address
Tel No.
Fax No.
Email:
5. Postal address (If different from above)
6. Arrival on
At
(time)
At
(time)
By
(mode)
By
(mode)
7. Departure on
6th night
8. Accommodation : required / not
required:
Dates
7th night
8th night
9. Will like to Present experiences / or
issue of
10. Travel supported by own organisation
11. If no in 10, then Require Fare
Yes
No
(estimate)
12. Any Special suggestions?
Date :
Place :
Signature
(Send back latest to reach us by 3rd October, 1999)
ii
1 jojy
Stef
L®'
ligf
H
81
BM
[0
ig
£
j^WLOh
tfgfi
teT|j
Td ^ Non
te®
Son
ill
a:
££
;p??
•«
o
_B
yw
W>
sS
SK
A New Global Health Policy
for the Twenty-First Century
JOK
g5t
apt M:
T0 V'*?
|feK 519
NOK
I
1e
x*
P-
WHO/PPE/PAC/9 7.3
ORIGiNAl; ENGLISH
DISTR.: LIMITED
s »v
Js?
fag
'’*U-?vfSTt7.G!tt “!’ ' V?OJg
l)
l
,0
.0
N®N6iQ
pr
•)vi
0
Wfr
NDg
jw? '®R
£
»w^Rtv
NW
3<
Sg
pg
’W '
'Sw bJ.KV^B^i^rai
3
gag
Sli
.9)1
££|S
Pf?
Outcome of a Formal Consultation with
Nongovernmental Organizations held at WHO Geneva
2 and 3 May 1997
WORLD HEALTH ORGANIZATION
WORLD HEALTH ORGANIZATION
IndMuak In NGOs vho made an intporlanl ‘
Spec,al thank,
to the preparation of this report:
‘Dr Giovanni Ballerla, Bahai Imernadonal Community
f
et owen> Healthfor Humanity
^ProfeSsorAnf^T'
and Titian Alliance
in ^national Medicine
^Mrs Irene Hn^
Assoc‘^n ofRetired Persons
^frs JoannaKoi’
a K h’ Associated Country Women of the World
Mrs Adrienne Taylor, Public Services International
of WHO s Policy Action Coordination (PAC) team
© World Health Organization 1997
' ■
translated, tn pan or m whole, without the prior permission of WHO No part of thrid”'1*"
be stored in a retaeval system or transmitted in any form or by any means - electronic
C’ rnecllanlcal or
other - without the prior written permission of WHO.
The views expressed in documents by named authors
are solely the responsibility of those authors.
Executive Summary
The WHO Policy Action Coordination Team convened a
formal consultation in Geneva on 2 and 3 May 1997 with
representatives of more than 130 nongovernmental organizations
(NGOs) to review the new global health policy, "Health for All in
the 21st Century."
The WHO/NGO consultation brought together not only
NGOs working directly in public health, but also those NGOs in
sectors that indirectly influence health, such as education,
agriculture, business, environment, and habitat, as well as NGOs
that address inter-related issues such as human rights, gender,
women, children and individuals with disabilities. Multisectoral
NGOs representing a broad and diverse spectrum of concerns
contributed specific examples from communities worldwide that
"health is everybody's business."
-> (
i
WHO’s major aims for the meeting were to consult NGOs
on global health policy development; to identify the potential roles
of NGOs in implementing the new global health policy; and to
identify, strengthen, and create new structures for NGOs to
collaborate with WHO at the local, national, regional and
international levels.
In the past five years, the series of United Nations Summits
have abundantly illustrated the immense influence of NGOs in
global policy development.
A Global Health Watch system, to be managed and
operated by an NGO group and modelled after Amnesty
International’s work in human rights, was proposed as a new
collaborative structure that could serve a crucial function in
stimulating the political will necessary to' prompt the timely
translation of policy into action and to monitor how well
governments, NGOs, and the private sector are fulfilling Health for
All responsibilities.
T
I
The views of NGOs which participated in this consultation
on renewing the Health for All strategy were explicit in calling for
NGOs to promote the adoption of a universal "Health for All Value
System." Its essential features include:
i
i
i
i
i
1) championing the importance of health as a human right
based on principles of social justice that maintain:
-Everyone is of equal worth
-Everyone is entitled to respect and personal autonomy
-Everyone is entitled
entitled to
her basic
be able
his or
to be
able to
meet his
or her
basic
to meet
needs.
2) promoting ethics, equity, solidarity and sustainability as
well as a gender perspective in all health policies.
The call for Health for All is fundamentally a call for social justice.
Specific priorities, such as promoting the advancement of
women and increasing the participation of women in
decision-making, have direct effects on health status. NGOs shared
a wealth of experience in approaches to influencing policy and
practice related to improving women’s health, with far-reaching
effects on policies and programmes on improving the well-being of
men, women, and children. Some NGOs expressed the opinion
that only when women are able to function as full partners in every
level of decision-making will the moral and psychological climate
necessary to attain Health for All be achieved.
There was common agreement amongst NGOs on the need
to promote a vision of health as being central to sustainable
development. They deplored the fact that 1.5 billion people around
the world still do not have access to basic health services.
Eradication of poverty is essential in all efforts to achieve a good
standard of health.
The NGO Forum for Health, a group of multinational
NGOs with a common interest in primary health care and global
health, stated that: "At its heart, Health for All is a moral and
ethical imperative. We call for a more profound definition of health
to include the spiritual dimension as an essential component."
Many NGOs echoed the belief that unless and until the
spiritual implications and ethical challenges of Health for All are
acknowledged fully and addressed systematically through a process
of consultation with all key players, including WHO, NGOs, and
governments, the achievement of Health for All will be hampered.
There was general agreement that WHO could work more
effectively with NGOs in the future if it were able to work with a
broader range of multisectoral NGOs and not just the narrow range
of NGOs now admitted into official relations with WHO. This
would mean a review of existing criteria and arrangements for
official relations with WHO, as well as a strengthening of WHO's
ii
*4
I
I.
/
f
I
■
current NGO liaison office to promote expanded partnerships and
working relations.
The renewed and strengthened partnership of WHO and
NGOs, and the efforts to reach out and involve the diverse
communities represented by the NGOs, contributed to promoting a
sense of hope and a vigorous renewal of effort in a spirit of world
citizenship to achieve the vision and aims of Health for All.
c
)
OR
!
iii
Chapter 3. Future action by NGOs to enhance health
The needfor a gender
perspective will be
vitalfor planning and
implementing policies
and strategies and is
complementary to the
advancement of equity.
Representing the most vulnerable groups
NGOs have a long experience of working with communities
and presenting their needs and priorities. In many countries, NGOs
provi e e only health care or social welfare services available to the
poorest and most vulnerable groups. They operate where no
government or formal health care services are available, often free of
charge, and work with volunteer staff or at very low cost. They are
much closer to the grass-roots of society than any government
services, or United Nations agency, and are in many cases the only
voice of these underserved populations. NGOs often complement and
support the work of formal government services. To enhance the
effectiveness of this work by NGOs, there must be better coordination
between WHO and NGOs, with clearer priorities and goals.
i
I
7
Equity and gender
Helping to ensure equity in health is one of the most important
contributions of NGOs, and there is ample evidence of their impact
in this area, particularly through their work with the most vulnerable
population groups. More particularly, NGO groups with a special
interest in women’s affairs and gender differences can have significant
influence in ensuring gender sensitivity in health policies and
practices through effective advocacy, information sharing and
lobbying.
WHO-NGO
partnership should be
open to all those that
^n contribute to
ertain issues within
the scope ofthe entire ■
work of WHO,
including the renewal
of the Health-for-All
Policy. Mechanisms
for ongoing NGO
consultations twice a
year should be
established.
NGOs have already played an important role in getting equity
and gender issues high on the development agenda through their
effective action at the numerous United Nations Conferences, and
Summits, of the past decade. NGOs'from all sectors played a
significant and successful role at these summits in consciousnessraising, advocacy for equity and gender equality, and lobbying of
governments and development agencies. This will continue to be a
vital contribution by NGOs in the future.
Many women’s groups had a strong focus on health, several
of which participated in the Geneva consultation on the new global
health policy, such as the All India Women’s Conference, Associated
Country Women of the World, International Council of Jewish
Women, as well as the Global Alliance for Women’s Health and the
International Community of Women Living with AIDS. For the
future, stronger alliances were needed amongst these NGOs, with
each partner identifying its specific strengths and future role.
8
0)
i
c
Healthy Women ’s Counselling Guide
Several NGOs ‘ recently joined WHO's Special Programme for
Research and Training in Tropical Diseases (TDR) in a project to advance
gender perspectives in health through the development of the Healthy
Women's Counselling Guide. This guide focuses on women's health in a
holistic sense across the lifespan, not restricted to their role as a mo±er or to
specific periods in their life.
A number of WHO technical programmes worked with a group of
women's interest NGOs to develop a series of clear and simple health
messages. These were to be distributed by NGOs and health workers to literate
and illiterate women. The messages were developed in collaboration with rural
women and community-based women's groups in Sierra Leone, Kenya and
. Nigeria in the form of "soap opera" radio tapes, and illustrated booklets. The
impact of the guide on women's health issues has involved a number of
international donors and foundations as well as the United Nations Drug
Control Programme in a model of participatory cooperation on gender and
.
health.
Advocacy and political support
NGOs can also play an important and increasing role in the
future in advocacy for health, drawing the attention of governments
to inequities in health services, in housing and education or in
exposure to environmental hazards. They already play an important
role in the political arena through successful lobbying of government
to address inequalities and social injustices. They exert considerable
influence on public opinion and act as the moral conscience of
society.
NGO Global Health Watch
NGOs at the Geneva consultation expressed deep concern that one
and a half billion people throughout the world still did not have access to
basic health care services. To address this glaring inequity, a group of
NGOs, known as the NGO Forum for Health, proposed to set up a Global
Health Watch to monitor how governments, United Nations agencies,
including WHO, and NGOs themselves were fulfilling their commitments
to Health for All.
The NGO Forum for Health, formerly known as the International
Primary Health Care Group, is long-established with members from a wide
range of multisectoral interests, and has a major focus on primary health
care and the Health-for-All Initiative. Its members are particularly wellplaced to monitor and report on equity in health and development at
country, regional and global levels.
9.
Today, the State faces
pressures from above,
below and within.
From above,
globalization of trade,
travel and
communication has in
some countries led to
marginalization from
world trade and
increased exposure to
a range of
transnational threats
to health. From
below, demandfor
decentralization and
the growth of local
government have
reduced the need for
centrally planned
policies.
NGOs and the changing role of government
The changing role of government is one striking feature of the
closing years of the twentieth century, which will become more
marked in the coming decades of the next century. There is certainly
a loss of power and prestige, as well as resources, in the government
sector, which has a significant impact on health and social welfare in
general. This is in part due to the economic constraints of the recent
past.
Privatization in the health sector, as well as in many other
sectors, is another trend which has an immediate impact on health.
Private enterprises, as well as nongovernmental organizations, are
stepping in to fulfil the role of government in many areas of health
care services. It is clear that market forces operating in the health
sector, if left unchecked, will prevent access to services by the poorest
and most vulnerable communities, operating counter to the principles
of equity.
If NGOs are to play an important role in the future by
providing services for the poorest groups and helping to ensure
equity, this means a closer collaboration with government and a clear
definition of roles for NGOs.
f;
It is clear that multisectoral NGOs, operating in all areas of
social development, will have an equally important role to play in
promoting health, working alongside and in partnership with NGOs
representing the health science professions and formal health care
sector.
Better coordination and cooperation
For the future, it is clear that NGOs could be much more
effective if their work was coordinated amongst themselves, and if
there was much closer cooperation with both the government sector
and the efforts of WHO and other development agencies. This will
require changes within both WHO and NGOs and give a broader
scope of interaction.
For joint policies and plans to achieve this greater cooperation
and coherence, there needs to be a much closer relationship between
NGOs and WHO, with joint policies and strategies for action, based
on common goals and a recognition of clear priorities. The expertise
of NGOs at country level, especially with the poorest communities,
should be clearly recognized by WHO, which lacks effective direct
contact with the grassroots levels of society. NGOs should be invited
by WHO to collaborate on policy formulation and strategy
development, instead of merely being’ acknowledged for their
successful implementation.
10
I
The criteria for
admitting NGOs into
official relations with
WHO should be
revised to take account
of the new policy
directions which
emphasize social
development. The new
criteria should
recognize different
organizational
structures for NGOs,
such as networks.
WHO should look more closely at effective mechanisms for
collaboration with NGOs and establish joint committees and
procedures for partnership in the health sector. Changes are needed'
both within WHO and within NGOs to facilitate these joint ventures,
and WHO could benefit in particular from the experience of NGO
groups in the many different sectors which impact on health, such as
education, environment, food and agriculture.
WHO can contribute by promoting the role of NGOs to
governments, and by emphasizing the complementarity of the NGO
contribution to health and health care. To facilitate this at the country
level, WHO country offices could make an inventory of the NGOs
working in each country, their resources and their areas of
cooperation. This would form the basis for a joint and coherent plan
of action for future cooperation on health between governments,
• NGOs and WHO or other international development agencies.
-V.’* :
-z •
.... ••
.
;•
NGO action on the Family and Medical Leave Act
The National Council of Jewish Women (NCJW) in the United
States has recently proposed significant changes in the Family and Medical
Leave Act to make provision for more parental involvement in children's
education and welfare. A comprehensive study carried out by the NCJW
called Parents as School Partners showed that constraints in both the
workplace and the school setting made it difficult for parents to participate
in school and community activities.
The findings of the NCJW study will be used to enhance
community participation in a wide range of projects, involving public
Information campaigns and information fairs.
.(
4
*
11
Possible Threats of Globalization for Health
Global Factors
Health Status
Consequences and possible
negative impact on:
Macroeconomic prescriptions
(e.g. SAPs*)
= marginalisation, poverty, inadequate
and decreased social safety nets
Trade
+ tobacco, illicit drugs and
alcohol, increased
marketing, availability and use
Travel
# infectious diseases South to
North; harmful lifestyles and products
North to South
Migration
+ inequalities and ethnic conflict leading to
refugee growth and civil conflict
Food security
+ greater vulnerability in Africa as China
imports more grain
Environment
+ global and local threats from rapidly
increasing, unsustainable consumer-led
demand .
Technology (direct medical)
# diagnosis outstrips treatment;
treatment increasingly unaffordable
for poor
Values
# equity and human rights under pressure
from global homogenizing forces
Foreign policy
# xenophobia, tough immigration laws as
some States try to isolate themselves
from global forces; threat to
multilateralism in face of common
global challenges
Communications and media
# marketing of health-damaging
behaviour; erosion of cultural diversity
=
+
#
possible short-term problem that could reverse in time
long-term impact profoundly negative
great uncertainty
* Structural Adjustment Programmes
14 .
€
I
“A Global
Health
Watch ” - Initial
overview
of
NGO initiatives
PREPARED FOR THE NGO FORUM FOR HEALTH, GENEVA
1. Introduction
During the last 15 years there has been a dramatic increase in the number of NG Os and an increase in their
areas of activities. Many of these NGOs fill a “watchdog” function, e.g. NGOs or networks of NGOs monitor
State's behaviour in relation to Human Rights (HR) and social security systems, or thev monitor the
environmental degradation, alerting the global and national community when action is needed. One common
feature of these “watchdogs” is that they are associations of human beings in their private sphere of life or
NGOs, coming together for a cause and acting as citizens with or without special expertise. This development
has been especially marked in the developing world. Civil society steps in where States fail to. are reluctant
to, or cannot act. Some of the most well known watches are active within the field of HR. such as Amnesty
and Human Rights Watch. These watches are prominent and have been successful within their field. Another
area where watches have had success and have been acting for a 10-15 year period is the environment (for
example Earthwatch, World Watch Institute and Earthscan). There is an emerging demand and need for a
“watch” to focus on health and public health.
This document will
1) present conclusions relevant for a Global Health Watch (GHW)
2) discuss likely parameters for'’success'; of a watch: What working methods, what level of cooperation and
with who, and what fomi of information dissemination has been successful9
3) give an example of a method for impact assessment of advocacy developed by the "Social Watch".
4) give an overview of NGO’s/watchcs active in the field of hcallh/hcallh rights.
For a description of NGO's contacted or discussed see annex 2.
2. Conclusions
to
be drawn
for
a
Global
Health
Watch
There is a need for a global network with z/nz/zWobjcclivc/focus on health and health rights, since
no such watch exists.
The founding idea of an NGO has to be a grassrool initiative, and cannot be fed into an NGO. There
arc today many initiatives within health. A GHW would profit from cooperaling/networking with
them.
The active participation of volunteers even within research has shown to be \ ciy successful and to
increase the sense of ownership: a GHW could be enriched b\- the energy that \oluntccrs provide.
Networks seems to be the most profitable way of cooperation, combining a unified goal with freedom
of work. This would also make it possible to profit from all the already existing NGOs working in
health and avoid duplication of efforts.
The rights perspective is increasingly common in all parts of the world!
Using scientific methods, striving for measurable comparable results gives crcdibililx. GHW could
benefit from cooperating with the Social Watch and their fulfilled commitments index, also
considering that their mandate partly covers health.
9
Considering the capacity for disseminating information and making an impact alreadv existing
within the NGO community, a GHW would profit from cooperating with most global NGO ’s
mentioned in this document.
“A Global
Health
Watch ” - Initial
overview
of
NGO initiatives
PREPARED FOR THE NGO FORUM FOR HEALTH . GENEVA
3. Determinants
Success
of
3.1 What is “success ” in this context?
Relating the success of these NGOs to their objective, which is genera11 j’ broad and unattainable (for
example, a world with “no human rights abuse ” or a world w ith ”no environmental damage") it is difficult
to measure results. In some cases however, clear results arc seen, such as Amnesty’s success in some of their
individual cases of political prisoners, China’s change of agricultural policy as a result of Lester Brown's
report Who wall feed China ’, the International Baby Food Action Network's (IBFAN) work together with
WHO and UNICEF on the International Code of Marketing of Breast-milk Substitutes which was
subsequently adopted by the World Healtli Assembly in 1981 or the fact that the Pugwash Conferences2 and
Joseph Rotblat received the Nobel Peace Prize in 1995 for the work on stopping the nuclear arms race.
Other signs of successful advocacy are less visible. Some NGO's have mentioned a change in the public
debate3, or that politicians and legislators use a vocabulaiy and concepts earlier introduced by that NGO.
SIPRI has pointed out that there is a discussion/dialoguc at all is a sign of success, since an NGO has a
unique possibility to provide a non committing forum for discussion/’ SIPRI also mentioned that the public
is more aware of issues relating to peace and conflict research now than 10 years ago. which can partlv be
ascribed to the work of all NGOs active in this field. Amnesty acknow ledges that the fact that work is being
done at all in certain fields, even if no tangible results can be shown, is belter than letting issues being
completely forgotten.
3.2 Possible denominators of success
Listed below arc some of the factors that the NGOs themselves identify during interviews as having been
important for tlicir success, sec also table in annex 1 for an oven iew of denominators. The watches perceive
their success differently and their work methods differ, explaining why not all factors arc applicable to all
watches. The factors listed arc core factors found in many successful watches.
Abbreviated version of table, annex 1
Ovci -mcw of Global NGOs am! determinants of success
1
Amnesty____________
Earth summit VV
Earthscan_________
Earthwatch________
2
4
5
£
X
X
X
X
x
x
x
X
Human Rights Watch
IBFAN___________
IPPNW___________
X
X
X
X
x
X
X
X
X
X
X
X
IPPF_____________
X
MarineWatch_______
Multinational Monitor
X
PRIO
8
X
GLOBE__________
Northwest Environment
7
X
X
X
X
X
X
x
X
X
X
1 The author Lester Brown is the director of World Watch Institute.
The Pugwash Conferences on Science and World Affairs, inception in 1957. members are scientists, some former nuclear engineers
3 Freds och konflikts forskning, Uppsala Universilel
4 Stockholm International Peace Research Institute (SIPRI). that acted as a bridge East-West during the Cold War. Inten icw Jean Pasqual Sander
23/9
“A Global
Health
Watch ” - Initial
overview
of
NGO initiatives
PREPARED FOR THE NGO FORUM FOR HEALTH, GENEVA
Project Ploughshares
x
Social Watch_______
X
The Pugwash Conf.
X
x
X
X
X
X
Women’s Rights Action
Alan Guttmacher Inst
X
X
X
X
X
Women Watch______
X
World Watch Institute
X
X
X
X
1. Grassroot initiative, 2. Combining research & advocacy, 3. Cooperation with national NGOs, 4. Credibility, 5. EiFective dissemination of
information, 6. Flexible networks, 7. Members professional status, 8. Participation of volunteers
“Being a grassroot/citizen’s initiative” (1)
That the NGO is a true grass root initiative has been shown to be a cornerstone of success. A movement
based on the initiative of people that have a strong urge to work/fight for their issue is immensely important
for the strength of a watch. An NGO with this foundation will have a large number of volunteers readv to
work for it and it will benefit tremendously by the word of mouth method of spreading their information. In
practice this is the core of a functioning, active, civil society. For examples, sec table in annex 1.
Active participation of members/volunteers (8)
Members of NGOs are involved to different degrees. They may hold a passive interest, they may actively
participate within designated fields or they may be involved in higher level functioning of the organisation.
To use members and volunteers in research missions and advocacy, has shown to be successful. For example.
Amnesty is a democratic organisation who s mandate is entirely defined by its members. Members also take
part in the research and fact finding missions together with employed researchers and representatives of the
organisation, besides acting as members on behalf of political prisoners. Earthwatch docs not conduct any
research without having the research teams consist of approximately 50% volunteers. In fact, Earlhwatch
builds its organisation on the idea of linking researchers and the public for a common cause. IBFAN is
another organisation that ascribes their success partly to the fact that their organisation is founded on grass
root initiatives.5
Cooperation with other national NGO's/Country representation (3)
In order to access information, to reach a broader population when disseminating information and to activate
people at the grass root level, many of the watches cooperate with national NGO's. Being affiliated with a
global reputable NGO also legitimizes the work of smaller NGOs in countries where civil society is not
functioning freely. In areas where it is impossible for national NGOs to function the watches have country
representation, or regular fact finding missions.
Credibility (4)
The information the watches 1) receive and 2) disseminate must be 100% reliable or the NGO will loose its
credibility, especially since the “watches'' function as a kind of citizens police. Manv of the successful
watches like Amnesty' and Human Rights Watch have developed systems to collect information and
rigorously assess it. By being active, independent and objective and at the same time identifying new
important issues many of the organisations have achieved credibility.
How is this done?
TheNGOs use renowned researchers employed long term by the NGO to perform fact finding missions and
conduct research, as well as in some eases members or volunteers. The watches constantly monitor activities
using tlie media, official documents and most importantly, the organisations ow n contacts on the ground, such
as local NGO s and like-minded organisations. Naturally information from reputable research institutions
s Tina Pfenninger IBFAN 22/9
“A Global
Health
Watch ” - Initial
overview
of
NGO initiatives
PREPARED FOR THE NGO FORUM FOR HEALTH, GENEVA
which^are not themselves trying to change public opinion is used. Also fact finding missions and in some
cases representational missions to influence a country' are used.6
Effective dissemination of information (5)
When the NGO has access to objective information it must inform the relevant population. For many of the
NGO s the target population is very large to achieve maximum impact in a global society. These factors have
been considered by successful watches:
*
I
Timing, some of the watches perform an analysis to get maximum impact for their report.7 World Watch
Institute tries to time their publications with for example large symposiums on different issues, such as
the tobacco and the climate issues.
• Accessibility/availability’. Information must be accessible and available both to professionals and laymen
to achieve broad recognition. For example “The State of War and Peace'"8 by D. Smith director of PRJO
is written in a pedagogical and easily accessible way, accessible to an interested member of the public.
World Watch Institute s yearly publication “State of the World ” is available in 28 languages and in a
number of universities.over the world. The use of new information technology like websites on internet
and e-mail has made information available to a vciy' large population previously not reached.
•
Targeting population -. If the target population is identified al the stage of writing a report it will get a
better public response. ‘Who will feed China” by Lester Brown, World Watch Institute, is an example
of that. Human Rights Watch has offices in all regions of the world to be able to target policy makers and
Flexible networks/cooperation (6)
Many NGO’s discussed in this document are networks of NGOs. following a loose organisational structure.
which seems to promote ideas and cooperation.
Members status (7)
Some NGOs lend credibility' of their members, that is the members professional background. These are the
NGOs where professionals, as individuals, have joined themselves together for a cause related to their
professional life. For example; the Pugwash movement where nuclear scientist arc working for a nuclear
weapon free world, and GLOBE, an association of legislators and policy makers working to enhance
cooperations between parliamentarians on global environmental issues.
Combination of research with advocacy and participation (2)
To combine performing research, with advocacy and participation of members is a fruitful work method
Prioritizing
For NGOs rath a broad mandate, prioritizing is difficult, but necessary. This implies choosing to act or not
6 Director, media programme .Amnesty, Anita Tiessen 24/9
7 Human Rights watcli, Susanne Osnos 23/9
8 Published by Penguin 1997, ISBN 01405137365
2
For example in Brussels, Tokyo (Japan is a major donor), and Washington.
“A Global
Health
Watch ” - Initial
overview
of
NGO initiatives
PREPARED FOR THE NGO FORUM FOR HEALTH, GENEVA
balancing urgency and the possibility' to make an impact with available resources. A pragmatic application
of International Law is required, i.e. to base the activities on the demands of the real world and then to apply
necessary and applicable international and national law.
3.3 System of measurement, qualitatively and quantitatively, an example
Not many NGOs have a formal system of measurement available for outside researchers, to evaluate the
impact of their advocacy. A system is a set of indicators, thus making comparison possible between projects
or even between NGO’s. However, many of the interviewees trust their “experience ”. This makes it difficult
to objectively conclude which methods of work have been more effective than others.
An exception is the newly instigated Social Watch and their “Fulfilled Commitments Index” (for a
description of the Social Watch see annex 2). The Social Watch has developed a sx'stcm of indicators, both
qualitative and quantitative, to measure the “rate” of fulfilment of a number of Conventions ratified by a
individual states. The}' divide their indicators into two categories “Political Will” and "Distance from Goals”
and have managed through a complex but comprehensive system to create internationally comparable
fulfilments status report for individual countries (see annex 3). Each category is di vidcd into subcategories,
and they in turn are divided into packages of variables. The Political Will category is aimed at measuring the
degree to which the governments express their political will to change social policy. The Distance from Goals
category describes how far or near a country is from what they have committed to.
4. Other
NGOs Involved
in Health
Some global NGO’s are involved with health related questions within specific areas, mostly regarding health
determinants. There are also a number of national NGO's involved in health, more or less focused on special
issues. As a result, there are a number of iniliatix es within many different areas of health, all striving towards
different goals. No NGO is working solely with a unified focus on human health and health rights.
Overview of global NGO’s activities in the health field
NGOs
Italics indicate
national NGO
Amnesty
HEALTH ACTIVITIES
'\mnesty fights torture’and has recently started to work for the elimination of female genital
nutilation (FGM). They organised a conference in Ghana 1996 on PGM and has a mailing
campaign.
Earth Summit Addresses health determinants. Monitors states fulfilment of promises made al the Earth Summit
Watch
n Rio, has the past 5 years monitored treaties in the follow ing areas: climate change, biodiversity,
forests and Agenda 21. Specific reports: An assessment of national action to implement agreenents made at the International Conference on Population and Development (for example
concerning the availability of family planning services), a report on the fulfilment of the Cairo
Programme of Action “Clean Drinking Water: A new Paradigm for Providing the World ’s
□rowing Population with Safe Drinking Water” and a report that lead to the global phase out of
eaded gasoline.
Earthscari
publisher
Publishes in the area of a sustainable development, specific areas regard children and the
environment and primaiy health care.
“A Global
Health
Watch ” - Initial
overview
of
NGO initiatives
PREPARED FOR THE NGO FORUM FOR HEALTH, GENEVA
Earthwatch
Dne of Earthwatch’s programme areas is World Health; projects studying Public Health and
ndigenous Systems of Resource Management and Medical Care. Specific projects are; “Maternal
dealth m Africa (Zimbabwe)”, “Helping the Homeless", and “Community Health in Cameroon”.
GLOBE
Dne of GLOBE’S working groups is dedicated to Human Health, while other working groups
iddress health determinants such as Fresh Water and Population. Specific outcomes of the Human
dealth working group are two action agendas: Children’s Environmental Health Action Agenda
md Sexual and Reproductive Health/Rights Action Agenda.
Harvard
empowers patients with concise accurate information to help readers make informed decisions
l¥pmen9s (and ibout their own care.
Men rs) Health
Watch
A Publication
Health
r r Action
■
i lnyo,ved >n health education and research, works mainly with community based organisations
Injormation work is emphasised on reproductive health.
Network
Health in Action Develops and maintains a centralised infonnation system on prevention and promotion programs
■esearch and evaluation initiatives in Alberta.
IBFAN
^ims at improving infant health through the protection of breastfeeding, and especially the
mplemcntation of the International Code of Marketing of Breast Milk Substitutes
International educates and advocates to prevent nuclear war (by humanising statistics) and antipersonnel mines
Physicians for the
Prevention of Nu
clear War
IPPF
’remotes the reproductive and health rights of women and men
Lymphovenous 'Xn NGO focused on the treatment and daily life of people sulfering from dysfunctioning lymphatic
Canada; Health systems. Monitors ti eatment and research of the disease.
ll^atch
Multinational Published by Essential Information Inc. “ tracks coiporatc activity, especially in the Third World
Monitor
bousing on the export of hazardous substances, worker health and safelv, and the environment Is
hsseminated in the Third World and the United Stales.
Social Watch
Founded after the Copenhagen Social Summit and the Beijing Conference to monitor and report
>n the implementation of conference commitments by governments and international
organisaions. It’s mandate covers health as a part of Social Policy. The Social Watch also uses public
wealth indicators to measure progress of social systems in individual countries
The Alan
Guttmachcr
Institute
Piotects repioductive lights oi individuals and families focusing particularly on young, poor or
Dtherwise disadvantaged people. Provides reliable infonnation on contraception, sexual activity
ibortion and child bearing.
’
"A Global
Health
Watch ” - Initial
overview
of
NGO initiatives
PREPARED FOR THE NGO FORUM FOR HEALTH, GENEVA
The
Monitors the implementation of the Convention on the Elimination of All Forms of Discrimination
International Against Women and the human rights of women under the other human rights treaties.
: Women’s
Rights Action
Watch
Welfare Watch Provides data on the consequences of implementing the new Welfare Act in the United States.
Wham!
Worldwatch
:■< Institute
\ direct action group committed to demanding, securing and defending absolute reproductive
freedom and quality health care for all women, in the United States.
Within health WWI focuses on life style issues such as smoking (the lessons that can be learned
from the west really makes it possible to act in other parts of the world). Earlier their focus was on
copulation and reproductive health.
A Global
Health
Watch
- Initial
overview
of
NGO initiatives
PREPARED FOR THE NGO FORUM FOR HEALTH, GENEVA
ANNEX 1
Overview of Global NGOs and determinants of success
A Citizen’s initia- Combination of Cooperation with
tive
research with ad national NGO’s
vocacy and par
ticipation
Amnesty
yes
yes
yes
Credibility
yes
Effective dissemi
Flexible
Member
nation of informa-Jnehvorks/forms of professi
tion
cooperation
tu
yes
yes
ye
some
Earth Summit
Watch
yes,
yes
after Earth summit in
Rio
yes
Earthscan
A publisher
.Earthwatch
yes
yes
yes
yes.
A leading publisher
publications in gen
eral ordered by other
org that disseminates
no.
yes
not a network
GLOBE
yes
no
yes
yes
Members arc legisla Annual conference
tors and
ind ongoing exchange
parliamentarians
of information
around the world
Human Rights
Watch
yes
Responded Io need in
lir groups in Moscow
and Warsaw
yes
yes
yes
yes
Closely cooperates
Scientific methods
Oilices in strategic
with HR monitors in ind proven to right on locations, strategic
oilier countries
numerous occasions plan for each report
published
ye
Members A
yes
Works like an um
brella organisation
“A Global
Health
Watch ” - Initial
overview
of
PREPARED FOR THE NGO FORUM FOR HEALTH, GENEVA
NGO INITIATIVES
A Citizen’s initia Combination of Cooperation with
tive
research with ad national NGO’s
vocacy: and par
ticipation
Social Watch
The Pugwash
Conferences
yes
yes
Credibility
Effective dissemi
Flexible
Members spec
nation of informa- networks/forms of professional s
tion
cooperation
tus
yes
yes,
yes
yes
manifesto issued by
B. Russel and A. Ein
stein
yes
Organisation of repu 'vfembers being policy
table scientist and
makers, so info
members of govern ]uickly reaches policx
ment
makers level
The International
Women’s Rights
Action Watch
yes
yes
Highly distinguis
participants with
rect possibility to
fluence policy
yes
The Alan
Guttmacher Insti
tute
no
Women Watch
(UN initiative)
no
Workhvatch Insti
tute
yes
yes
yes •
yes
yes
Publishes a wide
range of material and
educates
no
no
yes
no
UN information and
organisation
yes
?
yes
yes
timing, targeting and
planning
yes
“A Global
Health
Watch ” - Initial
overview
of
NGO initiatives
PREPARED FOR THE NGO FORUM FOR HEALTH, GENEVA
A Citizen’s ihitia- <Combination of Coopcratiori with
tive
research
’ with
• * ad- national NGO’s
vocacy and par
ticipation :
IBFAN
yes
Credibility
Effective dissemi
Flexible
Memb
nation of informa-|networks/formsof profes
tion
yes,
yes
is a network
IPPNW
IPPF
yes
no
yes
yes
by leaders of family combines advocacy.
planning associations expert panels and par
in Bombay
ticipation
yes
Multinational
Monitor
no
yes
no
yes.
yes
yes
PRIO
Research Inst.
Project Plough
shares
no
yes
yes,
9
yes
is a federation of au a major
tonomous and
planni
voluntary associations
9
yes,
no
yes
yes
yes,
yes.
yes
highly renowned re Publications are ac
searchers
cessible. popular and
timed
yes
uses data to influence cooperates with re
Canadian government searchers in Africa,
Sweden and the EU
?
no
Wide distribution in
region
individual researchers
yes
yes
IPPF is an interna uses scientific meth
ods with advisory ex
tional network
pert panels
Marine Watch
a publication
Northwest Envi
ronment Watch linked to Worldwatch
A publisher
Institute
partnership of 150
national groups
yes
yes,
cooperation
9
Publishing mainly
reaches Canadian gov
and donors
*
“A Global
Health
Watch ” - Initial
overview
of
NGO initiatives
PREPARED FOR THE NGO FORUM FOR HEALTH, GENEVA
Health in Action
Alberta Centre for Well Being
11759 Groat Rd, Edmonton, AB T5M 3K6, USA
Phone: +1 403 453 8692 Fax: +1 403 455 2092
e-mail: cjsmith@incentre.net
internet: www.health-in-action.org
HiA s aim is to maximise the effectiveness of
injuiy' prevention and health promotion programs
in the province (Alberta), by developing and
maintaining a centralised information system that
will consolidate descriptive information about
prevention and health promotion programs in
Alberta.
Health Action Information Network
9 Cabanatuan Rd, Philam Homes, Quezon City
1104, Philippines,
Phone: +63 2 927 6760 Fax: +63 2 927 6760
e-mail: hain@mnl.sequel.net
internet: www.hain.org
Involved in health education and research, pub
lishes the twice-a-month publication “The Drug
Monitor" to provide objective and independent
information on pharmaceuticals and the drug
industry.
Human Rights Watch
485 Fifth Avenue, New York, NY 10017-6104,
USA
Phone: +1 212 972 8450 Fax: +1 212 972 0905
e-mail: hrwnyc@hrw.org
internet: wwv.hrw.org
Investigates and exposes human rights violations,
globally. Challenges governments and stands with
national activists.
IBFAN The International Baby Food Action
Network (Tina Pfenninger 22/9)
Europe Regional Office
GIFA, PO Box 157, CH-1211 Geneva 219, Swit
zerland
Phone: +41 22 798 89 64 Fax: +41 22 798 44 43
e-mail: philipec@ipro.Iink.ch
internet: www.IBFAN.org
Aims at improving infant health through the pro
tection of breastfeeding. Implementation of the
International Code of Marketing of Breast-milk
Substitutes and subsequent World Health Assem
bly Resolutions relating to infant health are a key
part of IBFAN's work.
IPPNW International Physicians for the Pre
vention of Nuclear War
126 Rogers Street
Cambridge, MA 02142-1096, USA
Phone:+1 617 868 5050
Fax:+1 617 868 2560
e-mail: ippnwbos@igc.apc.org
internet: www.healthnet.org/IPPNW
Is a foundation of national medical associations
committed to the elimination of weapons of mass
destruction. Combining prophecy (describing the
reality), education and advocacy IPPNW have
been so successful that they received the Nobel
Peace Price in 1985. They have now broadened
their mandate to include land mines and other
weapons of mass destruction.
IPPF, International Planned Parenthood
Federation
Regent’s College, Inner Circle, Regent’s Park,
London NW1 4NS, United Kingdom
Phone: +44 171 487 7900
Fax: +44 171 487 7950
e-mail: info@ippf.org
internet: www.ippf.org
Promotes and defends the reproductive and health
rights of women and men. In particular advances
family planning through information, advocacy
and services
"5
‘A Global
Health
Watch ” - Initial
overview
of
NGO initiatives
PREPARED FOR THE NGO FORUM FOR HEALTH , GENEVA
ANNEX 2
NGO ’s
INTERVIEWED OR INVESTIGATED
Amnesty
United Kingdom
99-119 Rosebery Ave, London EC 1R 4RE
Phone:+44 171 8146200 Fax:+44 171 8331510
e-mail: amnestyis@amnesty.org
internet: wv^w.amnestj'.org
Amnesty International aims at contributing to the
observance of human rights as set out in the Uni
versal Declaration of Human Rights, by promot
ing awareness, adherence and to oppose viola
tions of political freedoms.
Earth Summit Watch
1200 New York Ave., N. W., suite 400
Washington D.C. 20005 USA
Phone: +1 202 289 6868
Fax:+1 202 289 1060
internet: www.earthsummitwatch.org
Monitors action by governments to implement the
declarations made in the Earthsummit in Rio and
to move towards a sustainable development
Earthscan
Earthscan Publications Limited
120 Pentonville Rd, London N1 9JN, United
Kingdom
Phone: +44 171 278 0433
Fax: +44 171 278 1142
e-mail: earthinfo@earthscanco.uk
internet: www.earthscan.uk
Earlhscan is a publisher of books on environment
and sustainable development. It’s aim is to in
crease understanding of environmental issues anc
to influence opinion and policy to promote a sus
tainable development.
Earthwatch (Tom Coward 15/9)
680 Mt Auburn Street, PO Box 403 Watertown.
Massachusetts 02272, USA
Phone: +1 800 776 01 88 Fax: +1 617 926 8532
e-mail: info@earthwatch.org
internet: vwv.earthwatch.org
Supports scicnlific Held research through
volunteers and scientists working together (an
active partnership scientist-citizen), to improve
public understanding of a sustainable world.
Earthwatch believes that this will empower peoplc and governments to act as global citizens.
Essential Information Inc,
publisher of “Multinational Monitor'
Phone: +1 202 387 8030
e-mail: monitor@essential.org
MN tracks corporate activity in the Third World
focusing on the export of hazardous substances,
worker health and safety, labour union issues and
the environment
GLOBE Global Legislators for a Balanced
Environment
e-mail: globeinter@innet.be
internet: www.globe.org
enhances international cooperation between pariamentarians on global environmental issues.
Tries to provide a forum for parliamentarians to
orge balanced, informed policy responses to
pressing global environmental challenges.
Harvard Women ’s (an Men’s) Health Watch
164 Longwood Avenue
Boston, MA 02115
e-mail: hhp@warren.med.harvard.edu
internet: www.med.harvard.edu/publications
Mcwslcllcr from Harvard School of Public Health
that seeks to clarify issues around women's health
and to proved accurate information to help
readers make informed decisions about their own
care.
4
MA Global
I
Health
Watch ” - Initial
PREPARED FOR THE NGO FORUM
overview
of
NGO initiatives
FOR HEALTH, GENEVA
The Alan Guttmacher Institute
120 Wall Street,
10005 New York, N.Y. USA
Phone:+1 212 248 1111
Fax:+1 212 248 1951
e-mail: info@agi-usa.org
internet: www.agi-usa.org (att Beth Friedrich)
An independent not for profit corporation for
research, policy analysis and public education in
the field of reproductive health. Provides the pub
lic with the latest news releases, research findpublications and policy developments within
the field and publishes periodicals such
as “Family Planning Perspectives'^ and “State
Reproductive Health Monitor’
Welfare Watch
the Annenberg School of Communication
University of Southern California
internet: www.welfare.org
WW is an information centre for legislators, citi
zen activists, journalists and the general public
and pio\ ides data on the implementation and
effects of the Welfare Reform Act.
Wham!
P.O. Box 733, NYC 10009, USA 1
Phone:+1 202 560 71 77
internet: www.echonyc.com/~wham/wha m. h 11 m
A direct action group committed to demanding,
securing, and defending absolute reproductive
freedom and health care for all women.
Worldwatch Institute
1776 Massachusetts Ave., N.W.
Washington D.C. 20036-1904, USA
Phone: +1 202 452 1999 Fax: +1 202 296 73 65
e-mail: worldwatch@worldwatch.org
internet: www.worldwatch.org
Conducls interdisciplinary non-partisan research
and widely disseminates the results of it in order
to foster the evolution of an environmentally sus
tainable society. Publishes \ carK “Stale of the
World". Lester Brown published highlv success
ful ‘‘Who will feed China?'*
e '
txJ- H-O
*
“A Global
Health
Watch ” - Initial
overview
of
NGO initiatives
PREPARED FOR THE NGO FORUM FOR HEALTH, GENEVA
Marine Watch
PO Box 810, Point Reyes Station,
CA 94956 USA
Phone:+1 415 663 8700
Fax:+1 415 663 8784
An international news journal focused on the
Earth's oceans, in depth substantive reporting
aimed at the reader with a high level of compre
hension
e-mail: subscriptions@marinewatch.com
internet: www.marinewatch.com
Northwest Environment Watch
1402 Third Avenue, suite 1127
Seattle, WA 98101-9743
Phone: +1 202 447 1880 or+1 888 643 9820
e-mail: new@northwesrivatch.org
internet: www.northwesrivatch.org
Research and publishing organisation, fosters a
sustainable economy and way of life in the Pacific
Northwest.
PRIO International Peace Research Institute
Oslo
Fuglehauggata 11, N-0560 Olso, Norway
Phone: +47 22 55 71 50 Fax: +47 22 *55 84 22
e-mail: info@prio.no
internet: http://macink44.uio.no
PRIO is an independent international institution
conducting information activities trough semi
nars, guest researchers and publications, for ex
ample “Stale of War and Peace Allas" by Dan
Smith.
Project Ploughshares
Institute of Peace and Conflict Studies, Conrad
Grebel College, Waterloo, Ontario, Canada N2L
3G6, Canada
Phone: +1 519 888 6541 Fax: +1 519 885 0806
e-mail: plough@waterserv 1 .uwatcrloo.ca
internet: http://waterscn' 1 .waterloo/~plough
Using publications, student participation and
letter writing campaigns to reduce Canada's mili
tary’ spending.
Social Watch
c/o IteM, Jackson 1132,
Montevideo 11200, Uruguay
Fax:+598 2 419 222
e-mail: socwatch@chasque.apc.org
internet: www.chasque.apc.org/socwatch/
Was established after the World Summit on So
cial Development in 1995 to produce an annual
report on the fulfilment of what was agreed at the
summit. The Social Watch is a network of global
watch dogs monitoring social development poli
cies. Reports arc produced inside each country by
NGOs actively working in social development.
The Pugwash Conferences
69 Rue de Lausanne
1202 Geneva Switzerland
Phone: +41 22 906 1651 Fax: +41 22 731 0194
e-mail: pugwash@hei.unige.ch
Strives to bring together influential scholars and
public figures concerned with disarmament and a
nuclear free world seeking solutions for global
problems
IWRAW The International Women’s Rights
Action Watch
Humphrey Institute, 301- 19th Avenue South
Minneapolis, MN 55455 USA
Phone:+1 612 625 5093
Fax:+1 612 624 0068
e-mail: i\\Taw@hhh.umn.edu
A global network of individuals and organisations
that monitors the implementation of human rights
of women. Independently reports to the human
rights bodies.
I
\ \ M 'S- <=)
On Novi and 2 i993; atthe\Vorid Health Organization’s headquartersin Geneva.an internationalgroupofexperts mettodiscuss;)
the potential health impacts of climate change. The meeting was organised for the WHO Division of Environmental Health and wasj ||
chaired by DnRudi Slooff of WHO. Their task is now to update and expand the 1990 WHO publication Potential Health Effects ofd g
B
Climate Change. They will also contribute to the work of the IntergovernmentalPanel on Climate Change, especially to the working^ g
•group on Impacts of climate change. The proposed WHO publication is planned for 1995 and will Include contributions on directs
effects of increased temperatures on cardiovascular and cerebrovascular deaths besides potential impacts on vector-borne.iJ
diseases, other communicable diseases such as cholera and algal biotoxin poisoning, effects on fresh water supply and food.?
production, and impacts of a rise in sea level. Almost all these topics were covered in a Lancet senes, that ends this week with the.^
initiation of a discussion of questions to be tackled by the WHO group-namely, how to monitor poss.ble health effects and what j
strategies are needed to prevent them.
j.
Globa! health watch: monitoring impacts of environmental change j
Andrew Haines, Paul R Epstein, Anthony J McMichael, on behalf of an international panel*
The eleven articles published in The Lancet over the past
seven weeks have shown how anthropogenic damage to the
biosphere has potentially important implications for health.
The underlying processes are global in scale, and the
natural systems affected are part of earth’s life-supporting
infrastructure. This type of health risk thus differs
noticeably from more local environmental health hazards
that are usually addressed at a toxicological or
microbiological level. The impacts of global environmental
change on health may be indirect and present only after a
long delay. How can public health scientists predict and
monitor the population health impacts of this novel
challenge?1 We need to detect effects early so that
countermeasures can be developed ^nd tested, to find out if
there are previously unsuspected impacts, and to give
impetus to policies to reduce greenhouse gas emissions (and
other causes of global environmental change).
Climate change, the chosen focus of the Lancet series,
could affect health in a variety of ways. Direct effects of a
rise in temperature (particularly increases in the frequency
and intensity of heatwaves) may include deaths from
cardiovascular and cerebrovascular disease among the
Correspondence to: Prof Andrew Haines, Department of Primary
Health Care, UCLMS, Whittington Hospital, Highgate Hill,
London N19 5NF, UK
1464
-
■
elderly. Indirect effects are secondary, such as changes in
vector-bome diseases or crop production, and tertiary,
such as the social and economic impacts of environmental
refugees and conflict over fresh water supplies.2
■ ;
Traditional epidemiological monitoring of disease and
mortality has limitations because there may be undesirable
delays before changes in chronic diseases are detected.
Other approaches must also be used, including biological
4
■■
4
markers to give early warning of damage, the monitoring o
carriers of infection such as insects and rodents, and remote
sensing for large-scale monitoring. There is growing
---------------------------------------------------------------------- -------------------------------------------------------------------------------—--------------------------------------------------------------------------------------------------------------
'
j
■.
*Dr Paul R Epstein (Harvard Medical School, USA), Prof Andrew Haines
.
(UCLMS, Whittington Hospital, UK), Dr Martin Hugh-Jones (WHO
:
Collaborating Center, School of Veterinary Medicine. Louisiana State 4g
University, Baton Rouge. USA). Dr Charles F Hutchinson (College of .gT
Agriculture, University of Arizona. Tucson, USA), Prof Laurence
Kalkstein (University of Delaware. Newark. USA). Dr Steven A Uoy
(Harvard University. Cambridge, USA), Prof Anthony J McMichae
(University of Adelaide, South Australia), Dr Stephen S Morse,
(Rockefeller University, New York, USA). Dr Neville Nicholls (Bureau o
j
Meteorology Research Centre, Melbourne, Australia), Prof Martin Par
(Environmental Change Unit, University of Oxford, UK), Dr Jonathan a
(World Health Organization, Geneva, Switzerland), Dr Sandra P°sJ (World Watch Institute, Washington DC, USA), Dr KennethSherman (U
National Oceanic and Atmospheric Administration, NarranganS^_ ;W|
Rhode Island), and Dr Rudi Slooff (World Health Organization. Genev ,
•1
Switzerland).
______
Vol 342 • December lb
I
J'
a
GOES-W
135’W
NOAA-9
1430L
GMS (Japan)
140* E
LANOSAT 4
METEOR
(USSR)
EB
Observing System (GCOS) and a committee for GCOS has
now been set up. GCOS will, cover alt components of
atmosphere, biosphere, cryosphere, hydrosphere, and land
surface climate, and that coverage is. beyond the scope of
current monitoring programmes such as Global
Atmosphere Watch and the World Weather Watch network
of satellites, telecommunication, and data processing
facilities (figure 1).
Two other observing systems (ocean and terrestrial,
GOOS and GTOS) will enable GCOS to provide a fuller
picture. More than eighty international organisations and
programmes are involved in global environmental
monitoring, and the potential for overlap and lack of
coordination is great. Until now health has not been
adequately taken into account. A selection of these
organisations is shown in figure 2.
Efe
• SPOT (France)
III
LAM3SAT 5
GOES-E
< 75*W
MOS-1 (Japan)
■
INSAT (India)(
74«E
X'-<NOAA-7 0730L
METEOSAT (ESA)
3"Lonpitu<le
if
Figure 1: Earth observing satellites in operation (as of April,
<
& I T-.V
F
I-
I S'
ft
'<•
awareness of the need to link environmental issues with
health—for instance the 1993 World Bank report Investing
in Health includes forest and fresh water resources.3 We
argue for integration of health into existing and planned
environmental monitoring systems. In this final article we
consider five aspects of monitoring, with cross-reference to
the series where appropriate: biological, environmental,
and human health indicators; data needed to monitor
indicators; technology for measuring them; organisations
doing the work; and gaps in information.
Climate (Maskell et al, Oct 23)
The scientific assessment of climate change is being
updated by the Inter-Governmental Panel on Climate
Change (IPCC).4 The Second World Climate Conference
in Geneva (1990) recognised the need for a Global Climate
It
V
I
Direct Impacts (Kalkstein, Dec 4)
The direct effects of temperature on health are mainly
manifest as an increase in death rates amongst the elderly
during periods of high temperature and can best be detected
through analysis of mortality data collected daily. Such data
are currently available mainly in developed countries but
this information is needed for urban centres in less
developed countries. Aggregation of deaths into weekly or
monthly statistics is of much less value because an increase
in mortality tends to be short-lasting and may be followed
by a period of lower than expected mortality. Changes in
morbidity and in seasonal patterns of disease can be
detected in primary care data such as those collected from
sentinel general practices around the UK.5 This database
demonstrates, for instance, that consultations for asthma
^WCP.^-
____
IGAC
IG8P
GCTE
H
■
JGOFS
’
^
ptoga
/HOP
■ --
,
- •. ;
:■
IB
GCOS
International science programmes
(
) Experiments/projects
Figure 2: Links between major International global environmental organisations, programmes, and projects
: Connecting lines indicate organisational links or "memoranda of understanding". (Adapted from figure 5 in Global Environmental Change: the UK
Research Framework 1993, published by the UK Global Environmental Research Office, Swindon; this figure has been simplified to emphasise
W
I
i
i
i
i
i
i
i
I
•
International governmental organisations/programmes
iigT.
I
'
I
i
J
(sparc ^
International non-governmental organisations/programmes
1
I
I
-----^WCRPL"-------
GTOS
■
wW;-
'
I
'iUNDP.*
J
K
'■
I
I
GEMS
fill
,
)
Erwironment (UNEP), Meteorological (WMO). Education and Science (UNESCO), Health <WH0>Me, International bodies with UN Hn/ts-Global Environment (GEE), Climate Change (IPCC), Oceanographic (IOC), Man and B.osphere (MAB). Sc.ent.r.c
‘Human Dknensions (HOP), Terrestrial Ecosystems (GTEC), Geosphere-Biosphere (IGBP). Atmospheric Chemistry (IGAC), Oceanic Flux (JGOFS).
Stratospheric Processes (SPARE), Tropical Ocean and Atmosphere (TOGA). World Climate and Climate Research (WCP, WCRP).
fc—---------------- --------
1465
Mi
jii
oiospnere j"serves. Some of W l
•lid also h<“
1
erally composed of natural cver~_ a__
™^,&ra.^Xrx"ydi!'
are
*s
-1 need to be
agricultural,
fe
1-
?==?=—ss- w
W'
W’
^osomiasis, dengue’and^etXver.'
SISIS’
mortality rates and poo^hr^
Several types ofTemo^sens “
“■» ta
towards the end of the year The •P^S
SUnimer and
of Outers
^d make it possible ‘
consultations and hospital re^s 71. routine data
’
about
[arge populations.
Ecosystems (Dobson r-
ar|d Carper, Oct 30)
Ulnesses of pIants, birds
mdicators of envirnm
’.
and ----mammals
--can be
influence the growthTf pa 1Ibhealth- The fa,
actors which
competitors, predators , 77“ “d PeStS
nutricnrs,
°Jetor is disturbed at 7e?ame “Tth^
d'chnes and its resistance to '
SyStcm’s Alienee
Biomdicators are used to monitor
“ may dec"ase.
The abundance and distribution of7‘rOnmCnral toxins.
S>
h"" COrTelated with
°f
fli«-
animal and vector hahv
Can be used t0 indicate
satellites (figure n ha " tS’
/-ANDSAT and SPOT
respectively andh-iv h C reso,ut:ions of 30 m and 10 m
-d mosqu^S USNa^ t0/^h^ of ticks’
Administration is SDonY NaUOnal Aeronautics and Space
information fo “
control/ Improved sm^T
S' monitoring and
ifs
f
-
incorporated within th
SyStems should be
observation platforms Intent genCration °f earth
meteorological, topographic 7nd 7'°“ COmbining
must become moreacfessMe a.nd. eP;dcmi°iogical data
Climate change mav r b . d slmPler to use.
d-ases at the
on vcctor-bome
global warming isotke™, h’r
distributions. In
borne disease may fiw -n7 POle*.ards. and vectoryellowfever,8 16’C for v‘
SamC dirccti°n (lO’C for
malaria). Climate cJ7tgT“ T'?3’ 2°’C f°r falriPamm
which vector-bome Xeas«
altitude at
r
S Man and Biosphere
g
il
^5’
i
I
j\ X
J’-ij
latl AuXdtdekaa °,
•19n9d2gXareas a^s^Reia”'9® averages tor same period. Red shows .
<C^les Hutchinson)
1466
Vol 342 • December 11, 1993
■a
Sill
;( ...•...^-
K
fD^e?effe?.often?pe?tyre-:
S
nhv-r'
oaflems of disease t .
h Changes in seasonal
ly^^es
seasaial patterns
:<•:> ;l -.. ^ncenues In developed and developingcoun
'£Vecta' home diseases-.
...
A/2ae^C^3<era ’
?Viy■Primary care morbidity data, hospital admissions.
u t;.- .-•■-■■<:Margjn3 of distributions (latitude and altitude)
....
, ' ’
Freshwatersu
*. T "• S~ '
How • •'
is
.Daib-nxxtalltyd^.:-^^
Man heat Island effect)
.
G. .
populations' at different latitudes
■
.
x
...... Primary care data; heal field surveys, communicable■ ., disease surveillance .centres, remote sensing .'
..
Marine (and freshwater) ecosystems'■
-Local studies,(“sea truth"), communicable disease
surveillance centres, remote sensing
•
>..-•■
regions" especially In the Interior of continents
■ - -1'-‘rti • ■■'Tii--
:
• •-
:
/
toMyingregions
Critical regions
. .
. Local population surYelllance:
/
.
Skin cancers
I
Cataract
Emerging a,seases
diseases
tmerging
■ High and low latitudes (taking distribution of ozone
’ depletion Into account)
As for skin cancers
Areas of population movement or ecological change
Summary of maln elements of monitoring scheme
monitoring may be possible .through local primary care
facilities with health staff trained to diagnose malaria and
other conditions reliably and to keep accurate records.
In Latin America’ Chagas’ disease could be monitored in
Chde and Argentina’ gently at the edges of the endemic
are2' Schistosomiasis could also be susceptible to climate
[kj - cban£e> especially if irrigation patterns change. In the USA
B there is a possibility of the spread of five vector-bome
dlseases—tnaJaria, yellowfever, Rift Valley fever, dengue
fCVCr’ and arbovirus~induced encephalitides? The use of
fW 1116 SouLhem Oscillation Index, based on differences in
Ofe' atmospheric pressure, to predict outbreaks of Australian
cnGephnlitis was discussed by Nicholls.
O/f1
Climate change may result in the elimination of some
•Si**- vectors and/or pathogens—for instance, as a result of very
Oft hOt dry conditions’ as in Honduras (Almendares et al).
LocaI influcnces, such as deforestation,
deforestation, need
to be
be
need to
distinguished from climate change.
£
1
Is
Oft: Large marine ecosystems (Epstein and others
Nov 13)
Changes in coastal ecology from local and global influences
have direct impacts on health. Environmental monitoring
of nutrients, currents, algae, and fish must be supplemented
by: (1) monitoring algae for Vibrio choleras] (2) surveillance
& of coastal communities for cholera and for fish (eg,
ciguatera) and shellfish poisonings; and (3) surveillance of
coral reefs (warming and ultraviolet radiation may cause
bleaching10).
OS
Marine algal
detected by
by remote
remote sensing
Marine
algal blooms
blooms can
can be
be detected
sensing
& g and satellite radiometry is useful for monitoring sea surface
8 M
JemPeratures to
t0 guide sampling (figure 3/'
& temPeratures
3/ Microwave
bands <t0 measure salinity) may be helpful for following
®
B > particular
PartlcuIar toxic
mxic phytoplankton species. The next
I K generation
^ne^non of satellites (Sea WiFS, to be launched in early
1994) will improve monitoring. Remote sensing needs to be
supplemented by local sampling to examine individual
1
species of algae and zooplankton
x
associated with
g
g £ gastrointestinal pathogens and biotoxins. Data on winds
G .
and currents, nutrients (including nitrogen and phosphorus
■ '■
originating from sewage), fertilisers, and industrial
pollutants will help to determine when conditions are
propitious for the growth of algal blooms. In 1994 the
monitoring of large marine ecosystems (funded by the
Global Environment Facility) is scheduled for the Gulf of
K
i
■
■
Remote sensing,.measures of crop yield’ food access, and
nutrition from local surveys ’'
Cancer registries Epidemiological surveys
Epidemiological surveys
Identification of "new" syndrome or disease outbreak
population-based time series Laboratory characterisation
Guinea, then the Yellow Sea, and ultimately the world’s
other 50 coastal marine ecosystems.
A temperature increase of 2-S’C between 1990 and 2100 is
projected to lead to a rise in sea level of 48 cm.11 The impact
will depend on land subsidence, erosion, and the frequency
and intensity of storms.
There are currently 204 monitoring stations for sea level
rise with planned expansion to 306 in eighty-five countries.
Measurements are improving under the auspices of the
Global Seal Level Observing System (GLOSS), which has
a tide-gauge network. The countries most vulnerable to a
rise in sea level include Bangladesh, Egypt, Pakistan,
Indonesia, and Thailand, all with large and relatively poor
populations. Several low-lying islands such as Kiribati,
Tokelau, and the Maldives would also be in danger. The
health consequences will be direct (eg, due to flooding) and
indirect effects (eg, due to displacement of populations and
changes in vector habitats).
Fresh water
Fresh water is rapidly emerging as a limiting factor for
human development. Rivers, lakes, and underground
aquifers show widespread signs ,of degradation and
depletion, even as human demands on water resources rise
inexorably. Some twenty-six countries now have
indigenous water supplies of less than 1000 m3 per person
per year, a benchmark for chronic water scarcity. By the end
of this decade, some 300 million people in Africa—one third
of that continent’s projected population—will be living in
water-scarce countries.12 Although domestic water use
accounts for less than one-tenth of water use, there already
exists a large shortfall for safe drinking water. Globally, the
expansion of irrigated areas—which currently produce
one-third of the world’s food—has slowed to about 1% per
year whilst the world population grows annually by 1-7%.
Temperature increases resulting from the equivalent of a
doubling of the concentration of heat-trapping gases will
probably raise both evaporation and precipitation globally
by 7-15%. Rainfall patterns will shift, with some areas
getting more moisture and others less. Hurricanes and
monsoons may intensify and the sea level rise will salinate
some supplies of fresh water.13
There is no global monitoring of water quantity,
although most countries individually monitor the flows of
rivers and the levels of lakes. The Global Runoff Data
Vol 342 • December 11, 1993
I
. :, ' j r--
Measures of run-off, irrigation patterns, pollutant'
concentrations ^-.,: r..
jte
7
THE LANCET
1
Centre, under the auspices of the WMQ and based in
Koblenz, Germany, maintains a database on daily river
flows from 1664 stations in ninety-one countries. These
data could serve as a baseline for examining possible shifts
resulting from climate change were a global system to be
established.14 The monitoring of water quality on a global
scale is the responsibility of the WHO/UNEP Global
Environment Monitoring System (GEMS). It promotes
the measurement of about fifty indices of quality but
practice among the 340 stations in forty-one countries
varies considerably. The monitoring of pollutants and
bacteria are relevant to climate change because changes in
runoff may alter the concentrations; however, it is the use of
fertilisers and pesticides, irrigation patterns, and industrial
effluents that are key determinants of pollutant levels.15
A specific fresh water indicator of warming could be algal
blooms, measured as chlorophyll a. There is increasing
awareness of the formation of large floating masses of
blue-green algae. Certain species can produce toxins which
may be poisonous, and rashes, eye irritation, vomiting,
diarrhoea, and myalgia have occurred in people who swim
through algal blooms. The blooms are considered to be
caused by a combination of calm sunny periods and
sufficient nutrients, notably phosphorus.16
Food (Parry and Rosenzweig, Nov 27)
I
H
Several systems have been developed by international
agencies to provide early warning of food shortages, notably
in Africa. These systems rely on routine data of three sorts,
that indicate food supply, food access, and wellbeing. Data
obtained on the ground, such as food stocks and planted
areas early in the season, supplement satellite data to
indicate supply; food prices in local markets reflect access;
and anthropometric measures or, in extreme- cases,
mortality rates give evidence of health impacts on
populations.
Satellite data, as indicators of food supply and impending
famine, improve consistency among countries and are more
accurate and more timely than information had from
farmers or local markets, for example. “Greenness” indices
(red and near-infrared spectral reflectance) are available
from daily data from satellites. This index is linked closely
to cereal and forage production, and can be used to predict
locust infestations. Figure 4 illustrates this approach for
Ethiopia. Rainfall estimates are based on duration of cloud
cover (presumed to indicate rain).
One International Geosphere Biosphere Programme
project is a global network modelling crop yield responses
to environmental change. Another, jointly with an
International Social Science Council programme on
dimensions of human environmental change, will monitor
long-term changes in global land for agricultural use driven
by non-climatic influences such as population growth and
trade agreements.
Agricultural yields can also be affected by pests and
predators, which are themselves susceptible to climate
change. Potential examples from the USA are anaplasmosis
(a rickettsial disease .of cattle) and hornfly.17
Ozone (Lloyd and Jeevan and Kripke, Noy 6)
To assess the impact of enhanced ultraviolet-B (UV-B)
radiation resulting from stratospheric ozone depletion, two
trends must be monitored—global changes in column
ozone abundance and changes in UV-B flux at ground level.
Ozone trends have been monitored by instruments on a
1468
satellite,18
and by
ground-based
spectrometers.
Observations on trace gases (especially chlorine and
bromine containing compounds) that catalytically deplete
the ozone layer are needed to predict future trends in ozone
loss. A lightweight unmanned aircraft shows much promise
here; a fleet of them could fly for days or even weeks at a
time in the lower stratosphere and provide continuous data
that remote sensing techniques cannot.’ Serious
international cooperation on monitoring UV-B has only
just begun, although many governmental agencies are now
acquiring the expensive instrumentation. In the UK for
example the National Radiological Protection Board has
been monitoring solar UV (visible, UV-A, and erythemally
weighted UV-B) at three sites since 1988.19 Until recently,
only broad-band measurements of UV-B region were
available but we now have instruments that provide spectral
resolution, and serial data from Toronto, Canada,
published last month20 illustrate what can be achieved.
Epidemiological monitoring of skin cancers (basal cell,
squamous cell, melanoma), cataract, and other possibly
UV-B induced disorders of the eye are needed over a range
of latitudes. Recently studies have been initiated in
southern Chile, where there has been appreciable
stratospheric ozone depletion. Whilst data on melanoma
can be captured by cancer registry data, basal cell and
squamous cell cancers may be less reliably reported.
Reliable estimates of cataract prevalence are likely to
require periodic epidemiological surveys using a standard
system to grade lens opacity.21 However, these potential
effects may take years to become manifest so markers which
respond more rapidly are needed. The International
Agency for Research on Cancer is exploring methods of
making early estimates of changes in skin cancer risk. One
possibility is to use biological markers, for instance certain
dimer-forming mutations of the p53 gene in skin cells,
which appear to be related to UV exposure.22
Emerging Infectious diseases
Emerging infectious diseases are infections that are new in
the population or are rapidly increasing in incidence or
expanding in geographical range; examples are dengue, j
hantavirus pulmonary syndrome,23 and some haemorrhagic I
fevers. Most emerging diseases are caused by “microbial j
traffic”—that is, the introduction and dissemination of
existing agents into human populations either from other
species or from smaller populations. This process is often
precipitated by ecological or environmental change and is
facilitated by population movements and other social
factors. Re-emerging diseases are those that had been
decreasing but are now rapidly increasing again. Often
previously active control programmes against wellrecognised threats to public health have been allowed to
lapse.
Our capabilities for health monitoring and rapid
response are seriously fragmented, with insufficient
coordination and communication let alone provision for
future xieeds. Inexpensive reliable communications (eg, by
e-mail) arc still not available worldwide, although
initiatives such as SatelLife’s HealthNet, providing lowcost access to medical databases for remote areas, aod
Internet e-mail offer hope that this can soon be achieved. A
secondary network directly linking interested field
scientists could greatly aid early recognition,
In conventional epidemiological surveillance, only a
small fraction of cases may be recognised and reported.
With emerging diseases, even a single unusual incident can
Vol 342 • December 11
■■it
THE LANCET
a
This means a partnership between the technically advanced
nations with access to remote sensing capacity, for example,
and others. A global health monitoring network is essential
not only to determine the impact of climate change but also
to shape strategies to prevent climate change as far as
possible and mitigate those effects which do occur.
a
Wc thank the following for advice and information: Alexander Leaf, Mary
E Wilson, S Elwynn Taylor, Paul H Wise, Tord Kjelstrom, S Tascer
Hussain, Raymond L Hayes, Richard Levins, Ruth L Berkelman and
Ralph T Bryan, D Anderson, Guy de The, J LeDur, K Nuttal, and
KE Mott.
be significant and investigation of such a pointer requires
linked capabilities for clinical identification of a “new”
syndrome or disease outbreak, for the epidemiological
investigation of the event (usually the weakest link), and for
laboratory characterisation. Existing facilities with all the
necessary capabilities, including some WHO collaborating
centres for arboviruses and haemorrhagic fevers, can be a
starting-point. ProMED (International Program for
>
Monitoring Emerging Diseases) has lately been proposed
I and the idea is supported by the Federation of American
Scientists and by WHO. Targeting so-called “critical
W geographical areas” undergoing rapid ecological or
O demographic change would be most effective. US Centers
f
for disease Control and Prevention has lately set up a
programme on emerging diseases.
I
? Role of WHO
£ WHO could have a key role in coordinating a “Global
Health Watch” (in quotes because there is no such system)
C based on environmental health initiatives in its regional
centres.26 It will therefore need to be involved in the design
I. centres/
and implementation of aspects of GTOS and GOOS. It can
help select sentinel populations in critical regions where
specific impacts seem most likely. Monitoring of health and
. , .be «•linked
-t—| to information about the
climate change should
including
population growth.
health
picture,
global 1
Existing collaborative programmes with other UN agencies
[S' (FAO, ILO, UNEP) places WHO inaneexcellent position
uto promote interdisciplinary activity on climate and
lb-
ecosystem health
The WHO database Climcdat specifically focuses on
work on the public health aspects of global climate change,
it lists investigators, organisations, and projects dedicated
to research on climate health.! In addition the UN
International Decade for National Disaster Reduction can
provide practical inputt on preparedness and mitigation.
t.. .
11
Conclusion
.Greater integration of~ efforts; to collect data on health and
change is needed. Many of the
global environmental
<
potential
effects
and will
of
climate
change will be insidious
potent—- -,
take a long time to manifest themselves, and sometimes the
links between ecosystem damage and health are unclear.
M
However, the creation of a monitoring network must not be
- used as a “wait and see” argument against action to reduce
greenhouse gas emissions. The Framework Climate
Change Convention signed in Rio de Janeiro last year has
-•Wfe not yet come into force (it must first be ratified by fifty
40 countries) but may be in 1994. It stipulates only that
WM developed countries should reduce their carbon dioxide
emissions to 1990 levels by the year 2000?’ whereas the
IPCC states that a 60% reduction is required to stabilise
atmospheric concentrations.
Much of the burden of global environmental change may
fall on poorer countries, which are less well equipped to
’jg® monitor, and the danger is that monitoring will focus
disproportionately on the problems affecting the rich
bfejW nations. This raises important ethical and practical issues.
If monitoring is to be effective international collaboration •
BWa on epidemiological surveys, field studies, and routine data
collection to complement satellite data will have to improve.
Ilf you have information on new projects related to health effects of
MW. climate chan£e or desire information from the Chmedat database, please
contact: Division of Environmental Health, World Health Organrzauon,
CH-1211 Geneva 27, Switzerland.
’^SLVo1 342 ’ Dcccmbcr 1I> 1993
References
1 McMichael A. Global environmental change and human population
health: a conceptual and scientific challenge for epidemiology. Inc J
Epidemiol 1993; 22: 1-8.
2 Haines A, Fuchs C. Potential impacts on health of atmospheric change.
J Publ Health Med 1991; 13: 69-80.
3 World Bank. World development report 1993: investing in health,
world development indicators. Oxford: Oxford University Press, 1993.
4 Houghton JT, Collandcr BA, Vamey SK. Climate 1992: the
supplementary report to the IPCC scientific assessment. Cambridge
University Press, 1992.
5 Fleming DM, Norbury CA, Crombie TL. Annual and seasonal
variations in the incidence of common diseases. Roy Coll Gen Pract
Occ Pap 1991; no 53.
6 WHO Task Group. Potential health effects of climate change. Geneva:
WHO, 1990:58.
7 Epstein PR, Rogers DJ, Slooff R. Satellite imaging and vector-bome
disease. Lancet 1993; 341: 1404-06.
8 Maurice J. Fever in the urban jungle. New Sei Oct 16, 1993: 25.
9 Longstreth JA. Human health. In: Smith JB, Tirpak D, cds. The
potential effects of global climate change on the United States.
Washington, DC: Environmental Protection Agency, 1989.
10 Gleason DF, Wellington GM. Ultraviolet radiation and coral
bleaching. Nature 1993; 365: 836-38.
11 Wigley TMC, Raper SCV. Implications for climate and sea level of
revised of IPCC emission scenarios. Nature 1992; 357: 293.
12 Postel S. Last oasis: facing water scarcity. New York: W W Norton,
1992.
13 Waggoner PE. ed. Climate change and US water resources. New York:
Wiley, 1990.
14 Rodenburg E. Eyeless in Gaia: the state of global environmental
monitoring. Washington DC: World Resources Institute, 1991.
15 WHO Commission on Health and Environment. Our planet, our
health. Geneva: WHO, 1992.
16 Elder GH, Hunter PR, Codd GA. Hazardous freshwater cyanobacteria
(blue green algae). Lancet 1993; 341: 1519-20.
17 Rosenzweig C, Daniel MM. Agriculture. In: Smith JB, Tirpak D, eds.
The potential effects of global climate change in the United States.
Washington, DC: US Environmental Protection Agency, 1989.
18 Gleason JF, Bhania PK, Herman JR, et al. Record low global ozone in
1992. Science 1993; 260: 523-4.
19 Dean SF, Rawlinson Al, McKinlay AF, et al. NRPB solar radiation
measurement system. Radiol Protec Bull 1991; 124: 6-11.
20 Kerr JB, McElroy CT. Evidence for large upwards trends of
ultraviolet-B radiation linked to ozone depletion. Science 1993; 262:
1032-34.
21 Chylack L, Wolfe JK, Singer DM, et al. The lens opacities
classification system III. Arch Ophthalmol 1993; 111: 831-837.
22 Nakazawa H, English D, Randcll PL, et al. UV and skin cancer specific
P53 gene mutation in normal skin as biologically relevant exposure
measurement. Proc Nad Acad Sci (in press).
23 Centers for Disease Control and Prevention. Update: hantavirus
pulmonary syndrome—United States 1993.7/4Afz4 1993;270:2287-88.
24 Henderson DA. Surveillance systems and intergovernmental
cooperation. In: Morse SS, ed. Emerging viruses. New York: Oxford
University Press, 1993: 283-89.
25 Ledcrberg J, Shope RE, Oaks SC Jr, eds. Emerging infections:
microbial threats to health in the United States. Washington, DC:
National Academy Press, 1992.
26 World Health Organization. WHO consultation for the development
and use of environmental health indicators in the management of
environmental risks to human health. Geneva: WHO, 1993.
27 Brown K, Maddison D. The UK and the global environment: the
conventions on climate change and biological diversity. In: Pearce D,
ed. Blueprint 3; measuring sustainable development. London:
Earthscan (in press).
-
1469
►
>
•J
Reflections
on
i
a
Global Health Watch
by
Dr. Ravi Narayan,
Community Health Cell,
Society for Community Health Awareness, Research and Action,
No.367, Jakkasandra 1” Main, 1” Block, Koramangala,Bangalore - 560 034, India.
Phone : 91 - 80-553 15 18 & 552 53 72
Fax
: 91 - 80-553 33 58 (Mark Attn. Dr. Ravi Narayan, CHC)
Email : sochara@blr.vsnl.net. in
i
I
I
i
1
I
I
1
Reflections on a Global Health Watch
Ravi Narayan*, India
Background:
The idea of a Global Health Watch was first outlined by a group of professionals (1)
concerned about the health impacts of environmental change. They suggested that WHO in
collaboration with FAO, ILO, UNEP and others could play a key role in coordinating such an
initiative ‘to monitor health and climate change and link it to global health picture and
population growth’.
In May 1997, WHO organised a formal consultation with Non-Governmental organisations in
Geneva on a New Global Health Policy for the twenty first century (2). At this consultation,
the NGOs ‘expresed deep concern that one and a half billion people throughout the world still
did not have access to basic health services. To address this glaring inequity, a group of
NGOs known as the NGO Forum for Health (Formerly known as the International Primary
Health Care Group) proposed to set up a Global Health Watch to monitor how governments,
United Nations agencies, including WHO and NGOs themselves were fulfilling their
commitments to Health for AH’. By early 1998, through a process of informal consultation a
concept paper has been developed on such a watch - which takes the idea further (3).
These reflections are intended to provoke all those who have similar concerns, to think about
the issues of "Health Watching’ and what they, especially groups like the Memisa Mundi
International could do to make it a reality.
1. ‘WHY’ a health watch?
The Global health scenario is characterised by many alarming features:
i.
Disparities between and within countries, in both economic and health status is
becoming significant.
ii. Global environmental changes leading to global warming; loss of bio-diversity; and
deforestation all have a great impact on health
iii. Globalisation and the evolving trade / aid policies are detrimental to health especially
of those who are poor and marginalised.
iv. Downsizing of health systems support by government through increasing privatization
and market concepts such as ‘user fee’ and the consequent breakdown of the public
health system are reaching ‘crisis’ proportions.
v. The growth of the ‘arms industry’ complemented by growing racial/religious/ethnic
fundamentalism are resulting in small wars and continuing racial and ethnic conflicts
with devastating health consequences
*Dr. Ravi Narayan is the Coordinator of the Community Health Cell, Society for Community Health
Awareness Research and Action, Bangalore, India. He was part of a small informal team who
facilitated the evolution of a concept paper for a Global Health Watch, an initiative of the NGO
Forum for Health, Geneva. While drawing from this concept paper, he reflects on the Why? What?
Who? How? of a potential Global Health Watch and the challenges of such an initiative. These
reflections were presented at the Medicos Mundi International Meeting at Geneva in May 1998.
2
vi. A series of UN summits and conventions are promising Health for All by 2000;
charters of Rights of patients; Rights of children and so on but the translation of
rhetoric to reality is minimal.
A Health Watch is urgently needed to keep watch on all these trends and their effects on
Health of People.
2. ‘WHAT’ could it watch?
There’s much to watch. For a beginning, this could include:
i.
Equity between and within countries especially regional / class / caste / gender /
geography (rural vs urban) differences
ii. National Health commitments to Primary Health Care and their translation into
adequate health budgets and adequate training and placement of health human power.
iii. International Health policies of WHO, UNICEF, World Bank, WTO, keeping track of
their effects on health, especially of the poor.
iv. Industrial policies at National/Global level particularly focussing on
a) Industrial pollution b) Alcohol and Tobacco industry c) the Pharmaceutical
industry d) The anns/weapons industry
v. The Health of those affected by conflicts / disasters and wars and the effects on health
of responses such as embargos, sanctions and ‘relief activities’.
vi. Globalisation and its effects on Health of people and also on ‘means’ to health
including - basic survival issues Hike food availability, herbal medicine and so on.
The list can be enormous but some prioritization in the context of the Health of the poor
will be required.
3. ‘WHO’ will support or contribute to such a watch?
A Health Watch will need the support of a large number of groups if it has to do its work
effectively and meaningfully.
i.
Citizens groups and grassroots NGOs can contribute greatly by keeping their ‘ears to
the ground’ and watching the realities of health at the level of the lives of people
especially the poor.
ii. National and regional NGOs and coordinating networks and associations and the
increasing number of issue raising NGOs can contribute to the watch, providing data
on regional diversities and disparities and broader intersectoral issues.
3
iii. Research and advocacy groups can provide ‘valid’ data from their studies especially
community based and policy oriented.
iv. Professionals and professional associations can contribute technical expertise
especially in analysis and interpretation. A multidisciplinary approach and a strong
public health orientation are necessary.
v. Consumer groups and associations can provide data and support lobby / advocacy
with the ‘health watch’ findings.
vi. Other watches can share their health related data to reduce duplication of efforts.
vii. Regional networks of NGOs and International health agencies could provide access to
their data bases especially from their partner agencies at the community / local /
national levels.
viii. WHO and its regional offices could support with regular monitored data from
member countries and data from special surveys, research projects and programme
monitoring system.
An effective ‘Health Watch’ will need to be able to access all these resources without
getting controlled by one group - so that authenticity, accountability and objectivity are
maintained.
4. ‘HOW’ could such a watch function
The credibility and authenticity of the watch is crucial and its accountability ‘to watch on
behalf of the poor and disadvantaged’ who are most affected by the processes and trends
being watched.
An effective ‘watch’ will therefore have to be a combination of all these features.
Grassroots networks and citizens initiatives should be central.
Information collated and analysed should be credible.
-
The ‘rigorous’ research approach must be balanced with committed
dissemination and advocacy.
-
Local/national NGOs especially from the South must be actively involved and in the
lead, for it to be representative of a global democratic initiative.
information
- Its functioning should be flexible and responsive to emerging needs and concerns and
interactive with a large group of resource networks.
-
There must be a large component of participation by volunteers.
-
Data and reports must be effectively and widely disseminated to reach all those who
could participate in responsive action.
-
Inspite of its ‘activist’ concerns, the watch should be highly professional so that the
‘counter expertise’ generated is very evidence based.
4
5. Some unanswered questions
While the ‘Health Watch’ concept has been receiving increasing and enthusiastic support,
there are some unanswered questions:
How will the ‘data’ collected or disseminated by the ‘watch’ reach the people, the
community, the citizens groups - particularly the poorest communities who could
be empowered with this information to understand their situation and fight for their
rights?
How could such an initiative be prevented from becoming another north-dominated
and international NGO-dominated structure, providing solutions and top down
prescriptions to the governments and communities of the South in a condescending
or charitable way? How could the initiative be a truly democratic global process?
How could such a initiative keep its independence and objectivity and credibility
and not become subservient to the conditionalities of funding partners or
international agencies including WHO, who will contribute to it but also be
watched by it? How could the global health watch be a truly independent
Global Health Ombudsman?
Those who help to initiate and develop the watch will have to face these questions in the
days ahead.
6. Challenges ahead
The challenges of contributing / participating in the evolution of a Global Health Watch
are many:
It could be a strong commitment to building a truly equitous and ethical global society
and a healthy one
It could be a significant example of north-south solidarity
It could be an opportunity to relook globally and locally at our life styles; our values;
our societal relationships
Finally, it could be an opportunity for professionals to commit themselves with
courage to standing up for the poor and the marginalised and to making Health a reality
for all.
ARE WE READY FOR THIS CHALLENGE??
References
1. Haines, Andrew et al (1993)
Global Health Watch : monitoring impacts of environmental change
The Lancet, Vol. 342, Dec 11, 1993, p 1464-1469
2. World Health Organisation, (1997)
A new Global Health Policy for the Twenty first century : An NGO perspectiveReport of a formal consultation with NGOs held at WHO, Geneva, 2/3 May, 1997.
3. NGO Forum for Health (1997)
Concept paper for the Global Health Watch
Sept 97 - May 1998, NGO Forum for Health, Geneva.
(several stage drafts over 1the aperiod),
...
5
■r
NOTE
All those who would like to respond to these reflections and participate in the
process of actually evolving such a ‘Watch initiative’ are requested to :
♦ Send their comments/suggestions to Dr. Eric Ram, Chairman, NGO
Forum for Health, World Vision International, 6 Chemin de la Tourelle,
1209 Geneva, Switzerland.
Tel :+41 (22) 798 41 83
Fax : +41 (22) 798 65 47
Email : wvi.gva@iprolink,ch
A project feasibility proposal has already been circulated by the Forum.
Interactive dialogue would help the initiative ‘get on track’.
♦ A copy of the above marked to the author would be an opportunity for a
continued interactive dialogue as well.
Dr. Ravi Narayan,
Society for Community Health Awareness, Research and Action,
No.367, ‘Srinivasa Nilaya’, Jakkasandra I Main,
I Block, Koramangala, Bangalore - 560 034, India.
Tel : 91 - 80 -553 15 18 AND 91 - 80 - 552 53 72
Fax : 91 - 80 - 553 33 58 (mark Attn. Dr. Ravi Narayan, CHC)
Email : sochara@blr.vsnl.net.in
6
bi
TOWARDS A TAMIL NADU HEALTH WATCH
In 1994, the concept of a GHW was introduced in an article in ^Lancet. This was
highlighting the need to watch such global phenomenon as warming, pollution and
degradation of bio-diversity and their impact on Health. The mandate of such a Watch
was expanded during the late 90s especially in the context of the fall of the Asian Tigers
and the bitter experience of the South American economies. It became clear that such
global phenomena as Liberalization^ - Globalization and privatization and the gradual
retreat from HFA commitments of WHO and increase in power of international monetary
agencies on national policies, also lead to ill health directly and indirectly. There was
growing recognition of the need for an independent and credible ombudsman to monitor
growing inequality in health and development as well as monitor the negative health
impacts of various policies including economic, industrial, trade realted, both national
and internationally. Following upon meetings organised by the NGO Forum for Health at
Geneva on the whi^s, whats and hows of such a Watch organisation, it was decided to
hold national/regional meets to discuss this. As part of this program, there was a meeting
held in Bangalore November 7-8.
The Bangalore meeting decided »that there was a definite need for such a watchdog
network:
That inequities need to be documented -Asuch data is to a large extent available, but
whatever data is collected has to be sensitive to the socio-economic-cultural reality - that
this data has^le^ked back to the community from where it came - that any working
mechanism would undertake advocacy, and this would be done on the basis of an aware
and sensitive public.
This paper is an attempt to document the evolution of the concept of the GHW post the
Bangalore meeting.
Why? The Philosophical Framework
A watch is a process. It occurs constantly and is quick to highlight inequalities and
discrepancies. It is unencumbered by pressures from vested interests and its only
pressure is that of the values of justice and equity. The presence of a ‘watch’ implies that
there are inequities, and injustices, the fact that it is being wholeheartedly welcomed
shows that these inequities are not only present and large but growing.
At another level is the crucial understanding that Health is in fact intimately connected
with the whole of development, and no single intervention in isolation can bring about
any change for the better. A ‘watch’ is also a reflection of a feeling of unhappiness with
the complete and unchallenged adoption of the philosophy and goal of ‘materialistic
development’ along a ‘western’ ‘first world’ model, and the forcing of these upon us by
international agencies. If there is one thing that we have learnt in 50 years, it is the
absolute futility of top-down, prescriptive programs,, planned and implemented in
C:\OFFICE\RAKHAL\TN Health Watcli.doc
splendid isolation from the socio-economic-cultural milieu. Despite this experience, the
fact that such programs continue to be forced upon is disturbing to say the least.
At yet another level, there is a need for data. In black and white, to show and to
convince. This despite the recognition that data, any data, hides as well as reveals. Any
documentation - objective or subjective - is crucial to highlight, spread awareness and
mobilise. Moreover, such documentation (at various levels of watching) highlights the
intimate relationship between the global and local that is so easy to forget.
What? The focus
At the outset, one must understand that not only must we focus on the various inequalities
present and increasing, but also the context in which these inequalities arose. As much as
we must spread awareness amongst all levels of society regarding the inequalities we
must not forget to focus on the causes of these.
Watch organisations in the past have been broadly of two kinds some such as Health
Watch and Social Watch were formed with the specific mandate of monitoring the
implementation of the governments commitment to various conventions and summits it
signs. The other group like Amnesty, People’s Watch have a much broader mandate but
still focus only on Human Rights, democratic or civil rights violations.
Recognising that conventions and summits signed on the international arena present an
opportunity to use positive developments globally to push for changes Nationally, it is
important to realise that many of these conventions have clauses that are in fact
detrimental to us. It is also a fact that many such conventions are signed under political
and economic pressure.
Compared to these, the mandate of a Health Watch is vast. Even as we recognise the
intimate links of Health with every facet of development, we begin realising the vastness
of this canvas. From the effects of pollution and global warming, the effects of conflict
and war, market-forces, privatization, disinvestment, the possible sub-focusses are
infinite. However, one can keep justice and equity as the basis and focus on inequities at
various levels and relate these to the various forces, circumstances causing them.
How? The method
Data: There is already a lot of data present. This data is being and has been collected by
both governmental and non-governmental institutions. Like any data, much of these data
suffer from a lack of reliability. However, especially the government data like census
etc. are the most regular and wide ranging. Two other factors that are crucial before
using any data is one, the accessibility, and two, the sensitivity to the socio-economiccultural milieu.
Unless there is a regular source of data of equal reliability, it is impossible to ‘watch’ and
unless this data is accessible, it can’t be used. The socio-economic-cultural sensitivity of
C:\OFFICE\RAKHAL TN Health Watch doc
any data is vital especially when we are focussing on the causes of these inequities.
Though there are a large number of regular and even reliable sources on objective
indications like IMR, MMR, % malnourished, etc. vary often it impossible to
disaggregate these. Also the comparative lack of qualitative data means the loss of the
flavour of socio-economic-cultural milieu from this data.
Structure: Most people during the Bangalore workshop as well as subsequently during
individual meetings conceived of the ‘watch’ as a nodal organisation, where data from
various sources could be collated, analysed and relevantly and sensitively presented. The
separation of the function of ‘watching’ from primarily collecting data is crucial so that
the watcher does not lose the contextual focus in the complexities of the local problems.
Also, realising that along with collection of data lies the responsibility of ‘doing
something about what you find’, it is best to leave data collection to locally active and
respected institutions.
Thus, in the structure conceived, is a two way flow of information. Field data collected
by local grassroots level organisation (including government where relevant) being
passed on to a nodal ‘watch’ organisation. And passing back of a relevant analysis of the
data collected that may be used at one level by the local NGO to spread awareness and
mobilise and at another, analysis that can be used by pressure groups to influence policy
makers, and the general public.
Functions: Outputs
One important point stressed is that any presentation and analysis of data must be
relevant to the user. For example, discussing and showing globalisation as the cause of
ill health may be true at one level, but may not be appreciated at another, where the
physical actuality of lack of access to primary health care is more real than an open
market.
The Watch could bring out a bulletin where data from specific case studies/specific
communities are presented, compared and superficial analysis done. This bulletin would
be a regular source of information, education, help in awareness building as well as a
source of solidarity to the various groups that send in data. The Watch could also bring
out quarterly/half yearly reports that are collations and analysis of much larger amounts
of data that show trends etc and links to the causes be they environmental related,
globalisation related or policy related. This could be used at different levels and
especially for pressurising policy makers, academicians, researchers and bureaucrats.
At a certain point in certain situations, the ‘watch’ may also plan primary data
collections, this may be both objective and subjective.
Organisation
There would be broadly three aims to the Watch. One would be in charge of data
collection / documentation / publication. There would be one aim for research / analysis
C:\OFFICE\RAKHAL\TN Health Watch doc
and one for advocacy / public relations, etc. There is also the need to discuss funding. A
few general principles that include any funding must be
Dependence on any single source of funding would lead to a questioning of the two most
fundamental values of any ‘watch’ autonomy and credibility.
Conclusion
In this paper, I have tried to present my conception of a Watch agency that will monitor
inequities in health. By the very complexity in the definition and facets of Health, and
Health’s intimate connection with development as a whole, the canvas of such a ‘watch’
will be very very large. The underlying principles that form the bedrock are justice and
equity. Such a watch is not only sensitive of the inequities present and growing but also
aware of the reasons that these inequities arose and are growing. Such a Watch will
attempt to spread awareness amongst the public and use this mass support along with the
analysed data to bring about change in policy and society.
C:\OFFICE\RAKHAL\TN Health Wateh.doc
CjO rvx H v \ 5. I
Key Indicators for monitoring equity in health and health care
Indicators measuring differences
between groups ______________
1. Health determinants indicators: Prevalence and level of poverty
Educational levels
Adequate sanitation and safe water.
coverage________________
Under 5 year child mortality rate
2. Health status indicators :
Prevalence of child stunting
Recommended additional
indicators :
Maternal mortality ratio; Life
expectancy at birth;
Incidence/prevalence of relevant
infectious diseases; Infant mortality
rate and 1-4 year old mortality rate
expressed separately____________
3. Health care resource allocation Per capita distribution of qualified
personnel in selected categories
indicators :
Per capita distribution of service
facilities in primary, secondary,
tertiary and quaternary levels
Per capita distribution of total health
expenditures on personnel and
supplies, as well as facilities._____
Immunisation coverage
4. Health care utilization
Antenatal coverage
indicators:
% of births attended by a qualified
attendant
Current use of contraception
TB treatment completion rates
Cervical cancer screening rates
ndicator Categories-
VARIOUS HEALTH INFORMATION SYSTE
Systems
Objectives
Freq.
Coverage
Indicators measured
Census
Total count of
population with respect
to demographic social
and economic ch.
To generate the
statistical information
on births & deaths
Once in
ten
years
Nation
Demographic, social and
economic characteristics
Cont.
registrati
on
Nation (local)
SRS
To provide reliable
estimates of births &
deaths
Cont.
enumer
ation
National
State
S.Unit = 6671
Pop.= 0.6%
Births & Deaths by other
demographic and social
characteristics including
religion, literacy and
occupation___________
Births & Deaths with
age, sex, rural/ urban
MRS
To provide most
probable cause of
death for rural India
Cont.
enumer
ation
Nation and
State
Sample PHC
= 1,731
Deaths & Births
Age, sex and cause wise
death rates for rural
India
HMIS
To provide timely
aggregated information
on health upto PHC
level_______________
To provide state and
national level estimates
of fertility, IMR, practice
of FP, MCH care and
utilisation of MCH
services
. -
Cont.
Nation
Births & Deaths
Age and sex and cause
wise death rates
Ad
Nation
Fertility, IMR, FP
practice, MCH care and
utilisation of MCH
services by sex, age,
urban/rural,
caste/religion
CRS
NFHS
Others
MICS/R
CH
PezYtitity
_
Organis
by____
Ministry
Home a
Dept, o
Pancha
Police
Health
Revenu
Directo
of Cens
opm., E
and Sta
Health
Directo
ofH&F
and
Eco. an
Stat.__
Directo
ofH&F
Ministry
&FW
PL 3LIC HEALTH
["Public health ~|
Disease surveillance at district level: a model for developing
countries
T Jacob John, Reuben Samuel, Vinohar Balraj, Rohan John__________________________________________________
sssssrssss—:
in the netwom, regu
evaluating control measures.
Introduction
Public health cannot progress without disease
surveillance. For example, documenting the elimination
of polioviruses from any country requires that every case
of acute flaccid paralysis (AFP) is detected, reported,
investigated, and shown not to be due to poliovirus. The
same principle will apply to future targets for eradication,
such as measles. The need for early recognition of new or
resurgent infectious diseases has been illustrated by
several recent outbreaks such as Ebola virus disease in
Zaire and plague in India.14
The expanded programme on immunisation (EPI) has
achieved very high vaccine coverage in developing
countries, but the success of EPI can be measured only
by surveillance of vaccine-preventable diseases. Had
surveillance been designed from the very beginning of
EPI for poliomyelitis, the inadequacy of three doses of
oral vaccine in tropical/developing countries would have
been detected straight away, and poliomyelitis eradication
could have been achieved sooner?
More than 10 years ago, we established a vaccinepreventable-disease surveillance system in our district as
part of a project to control poliomyelitis, and later
expanded its scope. A brief preliminary report of our
experience is presented here in the hope that it will serve
as a model for other districts in India as well as in other
developing countries, especially where efforts are being
made to eliminate poliomyelitis.
Disease surveillance
The North Arcot district (area 12275 km2, population
about 5 million; capital, Vellore) is in the southern Indian
state of Tamil Nadu. During the course of this study the
Lancet 1998; 352: 58-61
Department of Clinical Virology, Christian Medical College
Hospital, Vellore, Tamil Nadu 632 004, India (Prof T J John frcpe .
R Samuel mbbs , V Balraj mo , R John mb )
Correspondence to: Prof T Jacob John
58
<«
d|sease surveillance model is replicable in developing countries for evaluating polio
district was divided in two, but for the purpose of this
report the name represents both districts. There are 12
municipal towns (population 30 000-250 000) and about
3000 villages organised in 38 development blocks (total
population 4 300000) in the district. The nodal centre
for surveillance consisted of one part-time senior medical
supervisor, one full-time medical officer, five field
workers, one typist, one car, four motorcycles, and one
personal computer.
Administrative approval was obtained to collect data
from all government health-care institutions (hospitals in
every town and primary-health centres in rural areas). A
list of all private hospitals in the district was prepared and
they were individually enrolled in the reporting network
by visits from the medical officer or field workers. Letters
requesting enrolment were written to as many private
clinics run by medical practitioners—particularly
paediatricians—as we were able to identify either through
professional associations or through surveys.
We began in 1984 with the reporting of AFP, measles,
pertussis, diphtheria, tetanus neonatorum, and tetanus in
older ages. 4 years later, rabies, encephalitis, meningitis,
and hepatitis were added. Private hospitals and clinics
were supplied with printed, self-addressed, post-paid
cards to be mailed as and when a listed disease was
diagnosed. The card had space for identification and
address of the patient; the diseases were listed with boxes
to mark the diagnosis. If a vaccine-preventable disease
was reported, the number of doses of the pertinent
vaccine taken by the child was also marked in boxes.
Because the staff of the government hospitals were too
busy to report each case, they were supplied with
notebooks, each page printed with the replica of two post
cards. Our field staff would copy the data from them
once every month. Municipal health offices in the towns
and the health centres in the villages submitted a line list
of vaccine-preventable diseases once a month through the
district health offices; ±ey did not mail cards nor fill in
the note books. Laboratory confirmation was not
THE LANCET • Vol 352 • July 4. 1998
»
■f
■
i
I
J
PUBLIC HEALTH
100%-i
75%-
1
g
O)
$50%-
—
25%-
i
|
■
y-
•V
•T
■
•-
■
■
0%-1
Private
reports
Govt
reports —
HP
WC
AFP
E&M
TN
RS
MS
TO
1115
378
150
79
11
8
412
23
191
98
116
102
16
27 1481
131
100%-|
75%-
m
g50%-
i
&
25%■
-it
0%J
TO
HP
WC
AFP E&M
TN
RS
MS
Private
623 161
20
3
17 154
14 138
reports
Govt r-■|
64
54
37
0
5
0
12 266
reoorts
Figure 1: Proportions of cases reported by private and
government reporting centres, North Arcot District, 1989 and
1995
Reported numbers of cases given below names of diseases.
HP=hepatitis: WC=whooping cough; AFP=acute flaccid paralysis;
E&M=encephalitis and meningitis; TN=tetanus neonatorum: RS=rabies;
MS=measles; and TO=tetanus in older people. Diphtheria not included
since cases were very few. Govt=govemment.
required for any diagnosis. Although case definitions were
supplied, compliance was not checked.
All data were entered in a computer and duplicate
reports (from different sources), if any, were deleted.
THE LANCET • Vol 352 • July 4, 1998
Diagnoses and their geographical distributions were
scanned daily by the medical officer. Every child with
AFP was visited by field staff and brought to our hospital
for clinical and virological diagnosis and acute care and
rehabilitation, at no cost to the family. The bus fare and
cost of food during travel were reimbursed. Any
clustering
of vaccine-preventable
diseases
was
investigated by a visit from the field staff, followed by the
medical officer, if it was deemed necessary. Intervention
by way of immunisation (eg, during measles outbreak) or
antimicrobials (eg, erythromycin to children in the
catarrhal stage of pertussis) was offered.
Disease summaries were printed in a monthly bulletin
(named NADHI, an acronym for North Arcot District
Health Information; nadhi, Tamil for river) and
distributed free of charge to all participating hospitals and
clinics, the health administration (state and national) and
the Indian and international offices of WHO and the
United Nations Children’s Fund (UNICEF). The
bulletin listed the names of physicians or institutions
against the diseases and numbers they had reported in the
preceding month. The number of reported cases was also
summarised by geographical location. In addition, the
bulletin reported monthly cases of blood-smear-positive
malaria (recorded by the district office of the national
malaria control programme) and the numbers of the
district residents detected to have HIV-1 infection by the
national HIV surveillance centre at Vellore, irrespective of
the reason for testing. The frequency of isolation of Vibrio
cholerae and Salmonella typhi, and the antibiotic sensitivity
pattern of the latter, were collected from one sentinel
laboratory and also published each month. Every issue of
the bulletin contained an article on a relevant and timely
topic of public health interest, or news alerts of outbreaks
or unusual infections.
The motive for health professionals to report cases was
maintained by periodic visits from the field staff; by
occasional continuing medical education meetings carried
out in the towns by the medical officer and a guest in
collaboration with professional associations; by regular
mailing of NADHI; and by the supply of free vaccines
(which we obtained from the national immunisation
programme) to the private doctors to use in their
immunisation clinics.
Results
Enrolment of reporting centres began in 1984; by 1985
all rural health centres and all government and private
hospitals were participating. Subsequently, numbers grew
with the opening of additional health centres and new
private hospitals, and the continued recruitment of
private clinics. In 1987, there were 111 government and
279 private reporting centres; in 1989, 143 government
and 381 private centres and in 1995, 197 (32%)
government and 426 (68%) private centres. Most (80%)
of the government centres are rural and most (66%)
private centres are urban.
The private centres reported about half the vaccinepreventable diseases in rural residents (46% in 1995) and
almost all (99%) in urban residents. Other diseases were
reported only by private centres and government
hospitals, but not by any government rural health centre.
The relative proportions of cases reported by the private
and government centres is shown in figure 1. With
increasing vaccine coverage (measured but not reported
59
PUBLIC HEALTH
1200
350
200
250
150
800(/)
tn
0)
0)
<n 600ro
O
cn
co
O
400-
Hepatitis
300
Acute flaccid paralysis
Malaria
1000-
$ 200
V)
co
100
V 150
100
50
200-
50
0-1
0
0
JW
i
i
i
i
i
i
i
i
i
ccccccccc
(ucucuajconsajnjcu
c6c6cic6c6c6coco
i
—I—1“I-!—*-I-
I r- icoioioiviicNicoi^iini
I co I O) I O I
00 00
CO C0O)O)CT)CT)CT)O)
00 0)
“ O)
O)O)O)CT)O)CT)CT)CT)O)
CT) CD CT) CT)
r.1I CO 1I “‘I ■ID I
lyDICglr^tOOKDlOl ▼h II CN
CT
“ O) CT) O)
O) O) CT)
00 00 00
O)
“
“
CT)
6)
CT) O) 0)0)0) 0) CT) CT)
lOOICDIOIr-HC'IICOI ’Jlini
CQ CO
— —O) —CT) —0) 0) CT) CD
0) O) O) CT)
O) CD CD
Year
Year
Year
J
I
25-1
1000-1
50n
</)<D
40-
800-
30-
600-
20-
in
I 400-
CO
(U
O
Meningitis
Measles
HIV infection
20-
<D
CD
CO
o
0J I
0-1
0-1
ccccccccc
tonjtunjtuajajratu
105-
200-
10-
15-
(BciticSciScuajrcjajco
—
>—>—»—>
—i
—i
I
I
I
I
I
I
I
accccccc
cucococococotoco
I
—>
I r- i oo I O) I o I r-tiojicoiTimi
OOCOOOa)CT)CT)CT)CT)CT)
CT) CT)
CT)CT)CT)CT)O)CT)CT)CT)CT)
CT) O)
Ilf) ICO ID- ICO ICT) IO IvH I CM ICO |t T I If) I
00 00 00 00
00(7)0)0)00)0
CT) 0)
CO ’66
CDO)CT)a)CT)CT)CT)CT)CT)O)CT)
0) CT) CT) CT)
Year
Year
I cxi
I 00 I CT) I O I
CT)
00 CO CD
*
0)
CT)
0)
CT)
0) O)
I coII
CT) O)
CD
CT)
CT) CT)
0)
in i
CT)
0)
Year
Figure 2: Reported cases of Infectious disease
here), the prevalence of reported vaccine-preventable
diseases has been reduced substantially, but that of other
cases have remained stable over the years. Malaria and
HIV-1 infection have shown alarming increases.
On several occasions outbreaks of measles and
pertussis were recognised very early and successfully
contained. The fact that we were interested in knowing
about diseases, and that intervention measures were
being taken, emboldened health personnel and citizens to
report other diseases perceived by them to be of public
health importance. Thus the system detected,
investigated, and reported outbreaks of human and
animal anthrax, resulting in a concerted effort by the
department of animal husbandry to control animal
anthrax. On three occasions we investigated reports of
bite by jackals (Cants aureus) in villages near woodland
and gave rabies prophylaxis to several people; the villagers
told us that in the past no-one had helped them even
when human rabies had occurred after jackal bites. The
sentinel laboratory report has enabled us to investigate
outbreaks of cholera and food poisoning and to help
resolve them. When an outbreak of typhoid fever
occurred due to a multidrug-resistant organism, the
bulletin alerted physicians and told them the correct
methods of diagnosis and treatment.
Although our primary objective was to control
poliomyelitis by improved vaccination guided by
surveillance, we believed from the beginning that a single
disease AFP surveillance was unlikely to motivate private60
sector physicians to cooperate fully. Moreover, the extra
effort needed to include other vaccine-preventable
diseases was thought to be small, but the data important.
Reviewing data on vaccine-preventable diseases up to
1984, we found that most of the rural health centres were
not reponing any cases; the excuse was that the workers
feared (not without reason) the consequences of
reporting, since the occurrence of vaccine-preventable
diseases was deemed indicative of their own lapses in
achieving immunisation targets. We had to overcome two
hurdles: to remove the fear of reporting from the
government-sector staff and to obtain private-sector
participation. Both have been achieved by the NADHI
system. If government-sector reporting alone had been
successfully strengthened, the majority of cases of AFP
and pertussis would have been missed. In 1995, pertussis
and neonatal tetanus were reported only by private
centres.
Most cases of rabies, encephalitis, and meningitis in
1989 and in 1995 were reported by the private sector. At
both times, most cases of hepatitis were reported by
private centres and most cases of tetanus beyond neonatal
age (mostly adults) by government reporting centres. It is
clear that successful disease surveillance must combine
the government and private health-care agencies. Urgent
steps are essential to investigate the causes of hepatitis,
encephalitis, and meningitis, and to design and deploy
control measures. With tetanus, for example, a concerted
effort to prevent neonatal tetanus by immunisation of
THE LANCET • Vol 352 • July 4. 1998
i
I
I
PUBLIC HEALTH
pregnant women has reduced its incidence substantially.
However, year-by-year more cases of tetanus among older
people were detected. Tetanus immumsation needs to be
targeted more widely to protect the entire susceptible
population.
We have verified the reporting efficiency of AFP and
have data (not presented) to show that it was near 100%.
The completeness of reporting of other diseases has not
been verified. However, we do know that most children
with measles are not brought to medical attention by the
family; hence only a fraction of cases are reported by
health-care workers. Yet, the annual seasonal peaks, their
declining trend over the years up to 1992 and the
widening of the inter-epidemic interval since then, all
suggest that NADHI has correctly reflected the time
trend of measles (figure 2).
The data on malaria and HIV-1 infection were those
already being generated by their own independent
systems and reported to the respective national agencies.
However, no-one has used the data nor examined time
trends at the district level before; the situation is alarming
for both diseases. In India, data on malaria are available
in nearly all districts, and on HIV-1 in several, but remain
hidden for want of a district-level information system.
Discussion
There are several shortcomings in this model. Perhaps the
most important is that it is run voluntarily by one private
institution; unless the government adopts it and replicates
it in other districts in the country, it will remain a
research project. Fortunately, moves are afoot to establish
a district-based disease surveillance system in India.
When surveillance is established in several or all districts,
the monthly disease-summary bulletin need not be
district-based, but instead could be at state level for large
countries such as India, or national level for small
countries. We have not been able to intervene to establish
aetiological diagnosis, epidemiological investigation, or
prevention, against hepatitis, encephalitis, or meningitis,
even when outbreaks were detected early. There is no
microbiology laboratory in any government hospital. In
this population of 5 million, there are only four
microbiology laboratories and all are in private hospitals.
Although the government has established a network of
rural and urban health-care institutions covering the
entire population—a very laudable achievement—
evidence-based diagnosis is deficient in primary and
secondary health care, and public health is paralysed for
want of epidemiological tools and expertise. Where we
have had intervention tools, such as vaccines, success has
been obvious.
Many other diseases of public-health importance are
not on our list of reportable diseases; this situation can be
remedied by increasing funds for surveillance. The
annual running expenses of NADHI, including printing
and mailing of the monthly bulletins free of charge, was
roughly 100000 Rupees, amounting to less than one US
cent per capita per year. If the government runs an
expanded disease-surveillance system and applies control
measures for infectious diseases, net economic profit in
addition to improvement of the health of the people is
likely.
For the sake of completion, we must point out that the
notification of a list of diseases is legally required in
Tamil Nadu State (Madras Public Health Act 1930) and
in every other state. However, hardly anyone complies
with this requirement because there has been no system
of enforcement. Paramedical workers in the rural health
centres are expected to send weekly summaries of
morbidity including vaccine-preventable diseases. Even
after establishing NADHI we found that rural health
centres did not report non-vaccine-preventable diseases,
partly because sick people prefer to seek help elsewhere.
Physicians, both in government and in private
institutions, face no consequences for not reporting
disease. Surveillance is not merely for statistics, but for
information for action. In the absence of action or at least
feedback even when action is not possible, people lose
interest in case notification. These problems are prevalent
in many developing countries. The NADHI model is a
practical and sustainable surveillance system. The system
is appropriate for developing countries because it is
inexpensive, and entails the participation of both
government and private health-care personnel. It can be
easily established and also improved upon.
This research was funded by grants from the Indian Council of Medical
Research, New Delhi and from the European Economic Community,
Brussels, for poliomyelitis control in the district. We thank the Directorate
of Public Health of the Tamil Nadu State and successive district health
officials who approved and participated in the project. Without the
cooperation and encouragement of participating physicians, the dedicated
services of the field, secretarial, and computer staff, this project would not
have been successful.
1
1
i
i
<1
■<
0
4
?<
I
■/
I
References
■ t
1
Sanchez A, Ksiazek TG, Rollin PE, et al. Reemergence of Ebola virus
in Africa. Emerg Infect Dis 1995; 1: 96-97.
2 Kumar S. Plague in India. Lancet 1994; 344: 941.
3 John TJ. Immunization against polioviruses in developing countries.
Rev Med Virol 1993; 3: 149-60.
!•*
•r
■>
F
THE LANCET • Vol 352 • luiv I.
61
V
1
NGO FORUM FOR HEALTH
GLOBAL HEALTH WATCH WORKSHOP
(18 May 1999 : 14.00 - 18.00 : Salle IX/UN)
BACKGROUND PAPER
Prepared by Ms. Asmita Naik, (B.A. Hons. Law, Solicitor), Consultant for Global Health Watch
INTRODUCTION
The idea of a Global Health Watch to act as an independent and credible monitor of inequalities
in the health status of different populations, and to promote a more even distribution of resources
to ensure equal health rights for all, was first raised in February 1997 by the NGO Forum for
Health. In September 1998, a Task Force was established and a feasibility study was begun to
consider the scope and potential of such a watch. Various steps have been taken since then to
further develop the idea including the production of various conceptual papers as well as
consultations with established watch mechanisms such as Social Watch and Amnesty
International, to explore potential areas of overlap and lessons learned. A survey of NGOs in the
Forum was also carried out to establish data collection activities and their relevance to a potential
Global Health Watch. Representatives of the task force also participated in a Rockefeller
Foundation workshop on the proposal of a health watch. The purpose of this background paper is
to gather many of the ideas which have emerged during this period and to raise key questions for
debate and clarification.
THE NEED FOR A GLOBAL HEALTH WATCH
The huge disparities in the health status of populations in the developing and developed world
are evident. Even within nations, there are major differences in the health condition of different
populations depending on class, gender, ethnicity, regional and geographical factors. The
following statistics illustrate these inequities:
Around 1.5 billion people live on less than US$1 per day
♦
The prevalence of child malnutrition reaches staggering proportions - 38% in Sri Lanka,
♦
45% in Vietnam, 66% in India, and 68% in Bangladesh over the period 1990-96
The average life expectancy in Least Developed Countries was just 62.2 in 1995,
♦
compared with 74.2 in industrialised countries
43% of the population in Least Developed Countries over the period 1990-96 had no
♦
access to safe water, 51 % had no access to health services and 64% had no access to
sanitation
(Source: World Bank/UNDP)
2
The question of health equity has drawn increasing attention in recent years from health
organisations and governments. The causes of these inequalities are deeply rooted in the world
economic and political order and WHO has categorically identified poverty as the greatest threat
to health. Modem day trends in globalisation, environmental degradation, civil wars,
privatisation of health care to name but a few, will in turn have an impact on the health enjoyed
by the world’s populations. Watch mechanisms have shown some success in recent years in the
areas of civil and political rights, social inequality and the environment, and this has led
commentators to ask whether the same approach can positively influence issues of health equity.
BASIC PRINCIPLES
A range of values and principles, such as equity, justice, human dignity, universality, gender
mainstreaming and sensitivity, and ethical codes of conduct have been touted as fundamental
principles for a global health watch. Most of these values are enshrined in existing UN human
rights treaties and the International Covenant on Economic, Social and Cultural Rights - ICESCR
(1966) recognises “the right of everyone to the enjoyment of the highest attainable standard of
physical and mental health” (art. 12.1).
The question of the implementation of socio-economic rights and the long-standing argument
that the root causes of such problems lie in world economic inequality and not only in the hands
of individual governments is recognised by ICESCR which says that state obligations are relative
and progressive, a state party should aim “to the maximum of its available resources, with a view
to achieving progressively the full .realization of the rights recognised in the present Covenant by
all appropriate meanso(art. 11.1). Thus a Global Health Watch would need to identify tangible
areas for monitoring and advocacy where individual governments and organisations have the
capacity to make positive changes.
It is also important to take a holistic approach to the issue of human rights and recognise that a
wide range of activities can count as implementation of the right to health, from administering
vaccinations at ground level to advocacy before UN human rights treaty bodies. This perspective
would embrace a variety of initiatives instead of viewing a rights based approach as something
totally new. The link between health and human rights needs to be further explored at the
conceptual level, including the impact of human rights violations on health: the impact of health
policies on human rights standards: and the commonalities between public health and human
rights strategies.
3
THE FUNCTION OF A GLOBAL HEALTH WATCH
The function of a Global Health Watch would be essentially to find information on inequalities
in health and then to take steps to encourage the responsible authorities to initiate change to
redress these injustices.
The focus of a Global Health Watch:
A global health watch would focus on the policy and practices of:
♦
♦
♦
♦
Governments
International organisations such as WHO, UNICEF, World Bank
Private sector organisations
International NGOs
To monitor the following aspects of their activities:
♦
♦
♦
♦
♦
♦
Fulfillment of commitments made in international agreements
Harmful effects of activities on the health of populations
Discrimination against certain groups based on class, caste, gender,
race, ethnicity, sexual orientation
Effectiveness of policies and practices
Efficiency, oversight and public accountability of operations
External input into policy development process
Possible activities of a Global Health Watch:
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
Monitoring data, treaties, and current issues and providing analysis and commentary
Data collection /alternate reporting
Dissemination and sharing of information
Advocacy - taking up issues with responsible authorities, raising public awareness, work
with the media
Policy development
Early warning function
Networking
Technical assistance to NGOs through training (e.g. data analysis, advocacy), sharing
best practices, capacity building
Resource mobilisation
Community intervention
4
Specific topics yvhich have been proposed as potential subjects for Global Health Watch
scrutiny:
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
International agreements such as Alma-Ata declaration in 1978, WHO Health for All,
Beijing Platform for Action, Population and Development Programme of Action (Cairo)
Age/gender mortality rates showing cause of death
Morbidity data from selected vulnerable populations
Disease surveillance making use of data on emerging and re-emerging diseases
Critical appraisal of reports produced by WHO
Pollution
Tobacco
Pharmaceutical drugs
Bio-technology industry
Alcohol
Embargoes
Sanctions
Signaling outbreak of communicable diseases
Developing measures and standards
Equal availability of basic needs for a healthy life, such as food, clean water, sanitation
Equal access to health care and removal of barriers, such as user fees
Prevalence of strong primary health care systems integrated into district health systems
Proportion of health care budgets spent on primary, secondary and tertiary care
Availability of trained health personnel
Community participation in health care
Monitoring of government policies across a range of sectors which may influence health
such as education, transport, energy, housing etc.
Maintenance of adequate health infrastructure, progress on water and sanitation
Effectiveness of disaster preparedness and unequal impact of natural disasters
Identify priority health needs
Timely response to global health challenges
Encourage international conventions on health
Inform research priorities
METHODOLOGY
Pre-requisites for the effective functioning of a Global Health Watch:
Consultations have taken place regarding the way in which a Global Health Watch would carry
out its work. Other watches have identified the following points as vital for the effective
functioning of a watch mechanism:
♦
♦
♦
A strong grassroots national base which interacts with a global network
Collection of accurate, reliable and unbiased data
Monitoring of data after collection
t..
5
♦
♦
♦
♦
♦
♦
Cooperation with other national and international NGOs in the collection and
dissemination of information
Effective dissemination of information in terms of style, content, timing, methods and
target groups
A flexible network of organisations with a strong central steering structure to identify
common goals and avoid duplication
Active participation of volunteers
Prioritization, this is especially important where there is a broad mandate dealing with
wide-ranging and complex issues
Monitoring and evaluation of the impact of the activities of the watch itself
Balancing research and advocacy activities
Sources of data:
♦
♦
♦
♦
NGOs
A survey has been conducted among members of the NGO Forum for Health which
showed that 67% of respondents collected data which may be relevant to a Global Health
Watch as it includes information on demographics, mortality and morbidity, health care
policies and practices and access to health care. This data is not comprehensive as it is
usually restricted to particular target groups such as women and children. It is being
collected for the purposes of advocacy, monitoring and public policy formulation.
International Organisations
International organisations monitor data provided by governments on a range of issues
such a population health, disease incidence, access to health care.
Examples - WHO is creating a global database on country health profiles and a health
systems performance index. WHO also has a programme and budget document which
can be used to check what is being achieved across the board. OECD also collects
statistics.
National governments
National government reports on health may be useful but vary enormously in quality.
Academia and research community
Partners'.
The Global Health Watch would liaise and coordinate with many different local, national and
international organisations and individuals including:
♦
♦
♦
♦
♦
♦
♦
Grassroots community groups
Advocacy groups
Health research and academia
Professionals and practitioners
Consumer groups
Other watch mechanisms
National, regional and international organisations
6
Benchmarks for progress:
Another issue is to evaluate, firstly, whether progress has been made regarding the health
situation of specific populations and secondly, whether Global Health Watch activities are
having an impact. External benchmarks may be used to establish comparisons between different
countries such as infant mortality rates, or internal benchmarks which carry out successive
measurements in the same place over a period of years, such as the rate of vaccinations.
Available indicators which have been identified include the UNDP Human Development Index
and the UNDP Gender-related Index, as well as an index developed by USAID. Measurements
would need to measure both the level of attainment and efforts which have been made.
ORGANISATION
The organisational framework is still under discussion but one possibility may be a network of
national health watches linked to a small secretariat which would coordinate watch activities
globally. Questions remain regarding the staffing of the secretariat, the membership and
governance and decision-making processes. Another important issue is how funding can be
generated which would allow the watch to maintain its independence from donors and have a
wide sustainable base.
NEXT STEPS
- The Workshop on 18 May will be held to obtain national, regional and global perspectives on
the establishment of a Global Health Watch.
- The feasibility study will continue with a consultation taking place in six countries to obtain
regional perspectives on a Global Health Watch and to establish lessons learned from other
watches. A set of recommendations will be prepared and a final report sent to potential donors. A
more formal workshop will be held to present the final report and explore ways of launching the
Global Health Watch, possibly in the year 2000.
CONTACT DETAILS
The idea of a Global Health Watch is at an evolutionary stage and we would very much welcome
your input, suggestions, contributions and participation. Please send comments to the following:
Eric Ram, World Vision, 6 Chemin de la Tourelle, 1209 Geneva, Switzerland.
Tel: (41 22) 798 41 83
Fax: (41 22) 798 65 47
E-mail: wvi.gva@iprolink.ch
VI
RELEVANCE OF EQUITY IN HEALTH AND
HEALTH CARE
A PRIORITY FOR TODAY
Routine health information often hides social gaps in health
and health care.
These gaps are unacceptably wide and they keep widening
throughout the world.
Government spending on social services, too, is being
constrained by many powerful pressures.
Countries are finding it difficult to implement equitable
policies and are often caught between considerations of
equity and short-term efficiency. There is a mistaken belief
that “too much emphasis on equity now will jeopardise
economic growth and perpetuate poverty and deprivation.
Hence equity in health and health care must be placed
higher on the public agenda.
J* I j
WHAT DOES EQUITY MEAN?
Equity means fairness
It means people’s needs rather than their social
privileges guide the distribution of opportunities for
social well-being.
Pursuing equity in health and health care means trying
to reduce avoidable and unnecessary social gaps in
health status and health services among groups with
different levels of social privileges while working
efficiently to achieve the greatest improvements for all
Equity in health care requires equity
(a) in the way health care resources are allocated
(b) in the way health services are actually received and
(c) in the way health services are paid for
It implies a commitment to ensure for all high standards of
real (not only theoretical) access, quality and acceptability
of health services.
Real access requires active efforts to remove a range of
important obstacles :
•
financial, geographical or physical barriers
•
logistical barriers like conflicting family or work
responsibilities
linguistic, cultural or educational barriers
•
•
barriers of a perception of low quality of the services
z
Widening gaps in health status as well as in health care
may be one of the most sensitive indicators of problems
with broad economic or social policy.
The term INEQUITY has moral and ethical dimensions. It
refers to differences that are unnecessary and avoidable
and are considered unfair and unjust.
Living in an inequitable society could harm health
through many economic, social, psychological and
physiological pathways.
Disregard for equity in health and health care means
disregard for guaranteeing equal opportunity for all to
achieve an acceptable level of health care.
It means that some people because of being
disadvantaged in society will experience unnecessary
suffering, physical disability or limited physical and
mental development or maybe even die before their
time.
Equity in health and health care is not only an ethical
need but also a pragmatic and practical imperative.
• Disregard for equity is socially destabilizing.
• Disregard for health equity is incompatible with
long-term productivity. No society can afford to
discard its human capital.
3
Economic growth does not automatically lead to
more equity. Economic growth can create
opportunities to achieve more equity, but only when
there is a strong commitment to equity and a
sustained series of actions towards that goal. More
importantly, equity in health development is possible
Many
even when growth is most constrained.
interventions in health sector can yield improvements
at relatively low cost.
Efficient strategies make the best use of available
resources, but savings in greater efficiency are
Equitable financing
unlikely to be sufficient.
methods must be sought.
Donor support must
reinforce, not undermine equitable policies.
CONSTITUTIONAL GUARANTEE
Says the Preamble to the WHO constitution,
1946:”The enjoyment of t6he highest attainable
standard of health is one of the fundamental rights of
every human being without distinction of race,
religion, political belief, economic or social
condition.”
Says the Constitution of India: “The Constitution of
India aims at the elimination of poverty, ignorance
and ill-health and directs the State to regard the
raising of the level of nutrition and the standard of
living of its people and the improvement of public
health and strength of the workers, men and women,
especially ensuring that children are given
opportunities and facilities to develop in a healthy
manner.”
Representing the same concern for equity in health
care, WHO developed the visionary global policy of
“Health for All by 2000 AD”. The Alma Ata
declaration, adopted in the 1978 World Health
Assembly, stated : “The existing gross inequality in
the health status of the people is unacceptable.” The
strategy of Primary Health care suggested to help
reach this goal was specifically designed to achieve
this equity effectively and efficiently even in settings
with severe resource constraints.
Compression of data to common health and health
care indices hide various disparities. To obtain a
clearer picture, data must be broken down according
to differences in socio-economic status, geographical
b
location, gender and race which reflect differences in
social advantage.
______________ Inequity in health
North-South divide, rich
At the global level
nations-poor nations
At the Central level
Low support, low and
decreasing budget
At the State level
Some worse than others
(allocations vary widely)
At the community level
Some more disadvantaged
than others - rural, tribals,
SC, marginalised, poor,
females, less educated
At the family level
Women, children,
child and the aged
girl
Factors leading to inequity
Over the years, many factors have contributed to
the inability of implementation of equitable policies.
Predominant among them are:
I
I.
Historically
• Socio-cultural norms
• Socially, culturally and behaviourally determined
roles and responsibilities
• Poverty
• Politics of selfishness and personal enhancement
• Population explosion
• Suppression of healthy lifestyles, habits and
health care behaviour
More recently
Continuing population growth leading to
changing health and demographic scenario
Industrial revolution
Globalisation, liberalisation and Structural
Adjustment Programme (SAP) leading to
diminished social spending with health sector
affected maximally
Communication revolution
Appearance of newly emerging and re-emerging
health problems
Environmental degradation
Imbalanced expenditure and health policies
favouring the better-off.
GENDER INEQUITY
A gender perspective is vital for planning and
implementing health policies and strategies. Gender
sensitivity should be a basic value in health policies.
A gender perspective includes:
• gender analysis and awareness,
• gender sensitivity to the special needs of women,
• enhancing the participation of women in policy
and decision-making and
• strengthening the dignity and self-worth and
capacity of women.
An analysis of the current status of the female sex in
India clearly reveals that from womb to tomb, most
of them are at a disadvantage compared to their male
peers. More important is the fact that these gender
differentials get worse in groups where other criteria
leading to inequity exist. Thus rural females are
worse off than urban females and tribal females are
worse off than rural non-tribal females.
%
INEQUITY IN A FEMALE’S LIFE FROM WOMB TO TOMB
PERIOD
INEQUITY ASPECTS
NEWBORN
*
Foeticide
NEONATE
*
Higher neonatal deaths
INFANCY
*
Higher IMR
PREADOLESCENCE
*
Less numbers than males
demographically
*
Higher prevalence of malnutrition,
higher degrees of malnutrition
*
Less educated
*
More abused
ADOLESCENCE
*
Learned helplessness
*
Establishment of “set” cultural
behaviour
*
Submissive
*
“Untouchable” during
menstruation
Males matter more
PREMARRIAGE AND
EARLY MARRIED
YEARS
*
Further, higher education
restricted
*
Early marriage
*
More abused
*
“Hawked for marriage”
*
Husband always comes first
*
The dowry menace
Dual role bread earner and
hearth/cooking/running a home
*
Adjustment (in-laws) problems
(<
MIDDLE AGE
*
Work, work, work!
*
Bear ill-health in silence
* Husband, children always come
first
* Eat last and left-overs as usual
MENO PAUSE
*
Little support from husband
*
Menopausal symptoms including
psychological problems
*
Often lonely and single
* No attention, love and care from
family members, no empathy
* Hardly any health care expertise
available for the health problems
of her age
DEATH
*
Cheaper
*
Not much to regret about
*
No accumulation of “Property
hungry relatives” hovering
around at death time
I
REPRODUCTIVE
PERIOD
*
Too Early, Too Close, Too Many
Pregnancies
*
Anaemia
*
Infections
* Promiscuous behaviour of
husband leading to many
infections like STDs
*
Financial constraints
*
Poor, inaccessible, expensive
health care facilities
*
Antenatal, natal, and postnatal
problems
*
Focus on tubectomies as the
family planning technique
Disregard for equity jeopardizes the health of
everyone because of spillover effects (crime,
infectious disease, increased cost of treatment than
for prevention).
What we now require is to proceed forwards from
information to action:
Public attention and consensus must be
mobilized to ensure political will for action.
Information alone is not enough.
Real changes are needed in resource allocation.
Some countries have been able to counterbalance
the strong tendency to allocate more to those
who already have more. It must be noted that
identifying and reaching those in greater need
requires conscious, focused efforts.
The best technical efforts are needed, not just
good intentions.
Health services alone will not suffice.
Committed Intersectoral cooperation and actions
are required.
i 3>
Health For All was a clarion call to overcome this
lack of equity. However, after the initial enthusiasm
the sustained support required for its success did not
materialise and like most good ideas it remained a
slogan — words with no teeth. The WHO admitting
this and in keeping with the changing circumstances,
thus proposed a new policy called “Renewing the
HF A strategy (RHFA) in which equity in health and
health as a human right are given prominence.
Says WHO in a recent document “Equity recognizes
that everyone is of equal worth, is entitled to respect,
personal autonomy and is able to meet ones’ basic
needs; an equitable health system ensures universal
access to adequate quality care without an excessive
burden on the individual”.
I L.
PARADIGM SHIFT IN EQUITY IN HEALTH AND
HEALTH CARE
SOCIAL PRIVILEGES
PEOPLE’S NEEDS
RICH, POWERFUL,
INFLUENTIAL
ALL (Specially the depriveddalits, tribals, rural, urban
poor)
HIGH STANDARDS FOR FEW
GREATEST IMPROVEMENTS
AND SHARING OF PROGRESS
FOR ALL
LEVEL DOWN
LEVEL UP
DEPENDENCY ON OUTSIDE
RESOURCES
SELF-RELIANT TECHNOLOGY
TOP-DOWN PATERNALISM
DEMOCRATIC UTILISATION
ACTS OF CHARITY
CAPACITY BUILDING
SHORT-TERM
LONG-TERM
RESTRICTED ACCESS
UNIVERSAL ACCESS
Global Health Watch
(National Level Meeting - India)
Background
The idea of a Global Health Watch to act as an independent and credible monitor of
inequalities in the health status of different populations, and to promote a more even
distribution of equal health rights for all was first raised in April 1997 by the NGO Forum
for Health. Since then, a task force was established and a feasibility study begun to
consider scope and potential of such a watch. The NGO Forum for Health had an indepth workshop on this issue in May 1999 during the last session of the World Health
Assembly, Geneva. Now, a series of National Level meetings are being held to debate
this further.
An India-level meeting was held in early October 1999, in partnership with the Society
for Community Health Awareness, Research and Action, Bangalore (Community Health
Cell) who have already been involved in the preliminary conceptual dialogue.
Date
Venue
Organised by
:
:
Participants
:
Output
7/8th October 1999.
Ashirvad, St. Mark's Road, Bangalore - 560 001.
NGO Forum for Health (Geneva);
Community Health Cell (Bangalore).
A cross-section of health groups were invited which included
WATCHES: Social Watch, Health Watch, Peoples, Watch, North
Arcot District Health Intelligence, Peoples Union for Cicil
Liberties-Kamataka.
GRASS ROOTS COMMUNITY GROUPS: Belaku Trust, Jana
Swasthya Sahayog, Rural Unit for Health and Social Affairs, All
India Peoples Science Network;
ADVOCACY GROUPS: Vimochana, PEACE.
HEALTH RESEARCH / ACADEMICS: Center for Enquiry into
Health and Allied Themes Jawaharlal Nehru University,
Foundation for research in Community Health, St. John’s Medical
College, Dept. Of Humanities-Indian Institute Of Technology.
HEALTH
Medicine,
Community
PROFESSIONALS:
Demography/Statistics, Epidemiology, Public Health policy,
Health Management.
CONSUMER GROUPS: GREAT, Public Affairs Center.
NATIONAL & REGIONAL ORGANISATIONS: Voluntary
Health Association of India, Medico Friends Circle.
REGIONAL ORGANISATIONS: Regional Office For Health and
Family Welfare, Kerala Shastra Sahitya Parishad.
The proceedings of this meeting and an informal country level
opinion survey among the participants of the meeting will feed into
a feasibility study now underway on the GHW idea.
Objectives of the Meeting
1. Dialogue on the concept / role of a Global Health Watch.
2. Inequalities, Inequities and problems relevant to the Indian
context to be included in the agenda of a Watch.
3. Learning from the scope and experience of other Watches and
networking in the Watch efforts'.
4. How to measure/monitor these inequalities? Existing source of
data? Access, transparency and validity?
5. The relevance, structure, framework and linkages of a 'Indian
Watch' linked to the emerging GHW.
DAY ONE
SESSION I;
Chair : Dr. V. Benjamin
Dr. V Benjamin, President of the Community Health Cell (CHC) was in the chair when
the participants responded to his request to begin the meeting by observing a two minute
silence for the poor and the marginalised sections of India. This was followed by a brief
welcome address by Dr.Thelma Narayan, Coordinator of CHC, who outlined the purpose
of the meeting and hoped that the two day workshop would be able to conceptualize the
idea of a global national body that would be able to keep an eye on the health
inequalities which are increasing and making life worse for the poor and marginalised a section of India she termed as the “social majority”. This was followed by a self
introduction made by all the participants. In all, there were about 40 participants for the
two day workshop from varied backgrounds including Government representative,
academics, physicians, NGOs with primarily research agendas, activist NGOs, individual
activists, economists, lawyers, management experts etc.,
Next, Dr. Ravi Narayan of CHC who had been involved in the Global Health Watch
(GHW) initiative since its inception by the NGO forum of the WHO, made a presentation
explaining the idea of GHW.
Originating as an article published in The Lancet in 1994, GHW as an idea for keeping a
watch on the environmental determinants of health, was taken up by the NGO Forum for
Health which transformed it into a concept for monitoring inequalities in health and
development, because it felt that the spirit of the Alma Ata declaration of 1978 had been
progressively frittered away by pursuance of vertical and reductionist policies. Partly
because of various vertical and disease oriented programs launched by WHO and other
international donor agencies and partially because of the rapid globalization that was
bringing about a new economic order, the poor marginalised sections of society were
being neglected and they had been at the receiving end of a iniquitous health care system.
The forum had realized the necessity of an independent ombudsman-like agency that
could keep a watch not only on health status of people in various countries, but also on
policies that had a direct or indirect effect on health.
Ravi told the meeting that although an organization had agreed to fund the entire
initiative, the forum had perceived the need to have a multisourced mechanism of funding
to ensure credibility and autonomy both absolutely essential in fulfilling its functions.
The conference in Geneva he had attended had dwelt on the problems that needed to be
addressed by the proposed GHW and the issues that should be “watched”. It had felt that
the liberalization - privatization - globalization phase of the present world had
necessitated that a watch is kept on the growing inequities on the national and
international levels. Specific focuses for the proposed watch included the issue of
inequity, health and development and other policies, conflicts and disasters and global
market exploitation. Other specific issues included global environmental degradation and
loss of biodiversity, downsizing of health systems and privatization, racial and ethnic
conflicts, various United Nations summits and conventions and their implementation. It
was well recognized that there was no shortage of data and that the only problem was that
2
it needed to be accessed and analyzed sensitively. He felt that NGOs, academic
institutions and other organizations could collect credible information, and if the Health
Watch group could act as a flexible and interactive network cooperating and combining a
mix of research and advocacy, a meaningful surveillance on health could be kept. This
would improve the status of the poor and marginalised in various parts of the world.
Ravi at the end of his presentation made the gathering aware of some of the issues that
were still unresolved and hoped that the discussion could attempt to look into them.
These were:
• How will data that is collected or ‘watched’ reach the people or their groups?
• How could the GHW be a truly democratic or global process in that it was not North
dominated, not funder directed or was not top-down or prescriptive?
• How could the initiative be
• Objective?
• Independent?
• Credible?
SESSION II
Learning from other Watches.
Chair : Dr.CM Francis CHC.
The forenoon session and most of the afternoon sessions were spent learning from other
groups in India who have been acting as a watch on various issues. Each presentation was
followed by a period of discussion where the participants asked for clarifications or
linked some ideas to the GHW campaign.
HEALTH WATCH
Dr. Gita Sen from the Indian Institute of Management, Bangalore, speaking on behalf of
the group Health Watch started by explaining the origins of her group after the ICPD
conference at Cairo in 1994. The group emerged as a platform of concerned individuals
who got together to monitor the commitments made by the Indian government while
signing the Cairo declaration on reproductive health, and has been having regional
consultations with various NGOs to collect information from field level workers in order
to confront and dialogue with Central government about its commitment to the ICPD
declaration. She felt that the post-ICPD phase had been important in changing the
government’s perspective on Reproductive and Child Health and population policies
because of the positive change seen at the global level, thus attempting to highlight how
something positive globally could be used push changes at the national level.
The participants learnt from Gita that the Health Watch that had emerged as a network of
organizations with similar agendas had decided to prioritize its activities and had focused
on two issues.
• Removal of targeted approach to family planning.
• Improving the quality of services.
She said that Health Watch had decided to concentrate on “how to change for the better”
rather than be negative in its approach. Working through a network of organizations and
3
individuals, it had organized a national and eight regional consultations besides some
quick field research that formed the basis of the national level meeting.
At the end of her presentation she shared her learnings from the entire process that has
been in place for five years.
• It was as difficult to maintain and run a network of people / NGOs for a long time, as
to continue grappling with the government.
• The relationships between larger and small groups need to be kept open in a ntework
and it is important to be accountable and democratic in its functioning for it to
continue.
• Government is very suspicious about Health Watch.
• Government cooperation is based on the individual personality of the concerned
bureaucrat and there is a need to institutionalize a mechanism by which a ‘watch’
could get continuous access to the government data and implementation machinery.
• As the health activities of the governments are being funded by the WB, it may be
necessary for the ‘watch’ to be part of WB’s appraisal group to get leverage / position
so as to effect change in policy.
Replying to questions, she explained that Health Watch was being funded by a number of
funders including the UNFPA, Ford Foundation, Me Arthurs Foundation and that the
network had not got to a stage where it had to decide on a common minimum program.
Rather the Health Watch remained a network of organizations with the ultimate goals
alluded to above. Gita Sen replied to Sabu that although Health Watch was seized of the
problem of ‘son preference’ almost in all parts of India, it had not focussed on it as an
issue.
Gita appreciated Thelma’s concern about the population lobby being behind the RCH
program and ended her presentation by expressing her fears that the Cairo goals may not
be achieved easily because both the politicians and the bureaucrats come from the
conservative middle class and because of the politicians returning to the field, the RCH
goals were being seen as too radical and there was reluctance to pursue the objectives.
The chair summarized the learning points of Dr. Sen’s presentation as follows:
> The importance of taking an opportunity when one arises - here the ICPD and using
it to bring about appropriate changes.
> The importance of involvement of bureaucrats and politicians.
> Networking with openness leading to relationship building and achievement of agreed
upon goals.
SOCIAL WATCH.
As Jagadananda was unable to represent Social Watch, Dr. Sunil Kaul presented the
paper prepared by the Center for Youth and Social Development (CYSD) Bhubaneshwar
and Voluntary Association Network of India (VANI) New Delhi on their behalf.
4
Social Watch arose as an NGO watch-dog system aimed at monitoring the commitments
made by the government at the world summit for Social Development at Copenhagen and
analyses social development policies and actions by state / non-state actors to achieve the
goals of the Copenhagen summit while bringing about equity. In India, CYSD and VANI
have been preparing a report annually to circulate it among government departments,
individuals and NGOs for public education and opinion building. Taking pro-poor /
marginalised positions on social or governance related inequities, it examines
government actions down to fundamental policy assumptions, and now proposes to foster
a mutually supportive and synergistic relationship between state and non-state actors
involved.
Sunil explained that Social Watch had chosen to analyze three major themes of social
development, namely Basic Entitlements which included learning, health and housing
etc., Sustainable livelihood including access to natural resources, strengthening skill base
and promotion of local enterprises, and Participation in governance. Social Watch picks
up indicators to measure the progress in literacy and basic education, keeping specific
linguistic and cultural contexts in mind and looks at issues of access to educational
opportunities and food, hygienic housing, sanitation and water and primary health care
especially for the children, mothers and the elderly. It measures the progress toward
achievement of goals regarding access to productive natural resources, promotion of local
enterprises, right to wages, maternity benefits etc., and examines the impact of modem
production systems on livelihood opportunities. It also analyses the role that Panchayat
Raj Institutions (PRI), dalits, tribals, and women play in governance, and the evolving
legal or operational space for participation of civil society organizations in collaborating
with the state in formulation of programs and policies.
Based on these, Social Watch has chosen indicators, which will help it to develop a
Social Development Index and an Adequacy of Action Taken Index.
Gita wondered if advocacy can be focused for issues of social development, because the
responsibility lies with a large disparate set of ministries and the society at large, unlike
health where there is the health ministry to pressurize. Anil Choudry felt it was not
necessary to focus on all commitments made at the world summits because many of them
were positively harmful for developing countries but had been signed under global
pressure. Lawrence felt that development of indices are yet another attempt at
meaningless reductionism, but Manjunath felt that it was a good mechanism to highlight
issues and carrying out advocacy. Pankaj stressed the importance of indicators though he
too felt that having indices might often hide realities. Ravi said that instead of focussing
on different levels of watching, we should watch and see how we can use the experience/
data gained at different levels.
5
NADHI
Dr.Reuben Samuel described how North Arcot District Health Intelligence came to be set
up as a Disease Surveillance system that was started initially to keep a tab on six of the
immunization preventable diseases, but gradually has increased its range to many others
like malaria, HIV hepatitis etc.,
Funded by the ICMR and a EC program he explained the system which was based on
pre-printed post cards left with the field workers who were to fill out the details on it by
observing an easily diagnosable disease, and post it to the center where they were fed into
computers and the data analyzed and a methodology was quickly set up to prevent an
outbreak in its vicinity.
He highlighted the way in which the system involved volunteers, private practitioners and
how it cost only about 5 paise per head of the 50 lakh population involved. He ended his
presentation by mentioning its limitations of being selective in its focus, and that it was
run by one private institution because of which replicability was not assured. He however
added that an attempt was being made to replicate it in a few districts in Kerala.
Dr. Mohan Rao attempted to clarify that GHW concept went far beyond a disease
surveillance system and was meant to include socio-economic and policy issues
surveillance. RN hoped that GHW, unlike the NADHI system must incorporate a
mechanism to report the data and analysis back to the people so that it becomes THEIR
issue.
Sunderraman, who has also been involved with NADHI was doubtful if it could be
replicated especially because he had seen the hostility and politics amongst the
professionals because of the methodology of the surveillance system. He felt that as
NADHI relied on Government and private practitioners, it missed a lot of ‘community’
perspective that may have been got by involving RMP’s and compounders etc., He hoped
GHW would involve the community in collecting information also.
Mohan Rao also felt the need of a system of information was highlighted by the
successful approach of NADHI.
Gururaj wondered if the data was compared with government’s data analysis and if the
people collecting the data understood the importance of collecting it. Nandakumar wished
that the disease surveillance system could include the issue of animal health as well. Sabu
wanted to highlight the fact that that the possibility of making money out of the survey
itself led to alteration in the quality of data.
The Chair summarized the learning points from this presentation as follows:
> Any source of data should be multiple and based on reliability / accessibility and
validity.
> For data to be relevant in a ‘watch’ setting it must include some socioeconomic
indicators.
6
> And the details of who was collecting data and how, are almost as important as the
data itself.
PEOPLES WATCH
Mr. Britto told the audience that his NGO had two objectives;
• To ensure state accountability leading to a change in policing.
• Promotion of a culture of human rights through strategic interventions and education.
Peoples watch monitors human rights violations through fact finding missions whenever
there is a report of custodial deaths or caste violence in Tamil Nadu . It also provides
legal assistance to victims of HR violations as it did for the victims of torture by the
Special Task Force set up to nab the sandalwood smuggler, Veerappan. It tries to
intervene by providing information to national and international human rights agencies
eg, the National Human Rights Commission and state HRCs. Peoples Watch also
promotes solidarity amongst victims of HR abuses and agencies promoting HRs. In the
past it had undertaken campaigns against Dalit atrocities and for repealing the
controversial POT A act (prevention of terrorist activities act)
Britto also listed out the number of publications Peoples Watch has brought out so as to
disseminate information about HR and on the performance of various national and
international HR agencies. It has also published the Supreme Court judgement on sexual
harassment in the workplace.
Peoples Watch also involves young lawyers and Law College students in HR orientation
and in HR Campaigns. It also takes up activities to train and update the knowledge of HR
activists and movement leaders. Recently, it has also undertaken a HR awareness
program in 400 schools missionary and municipal schools.
Replying to questions, Britto explained how his NGO had carried out a public inquest
into the causes of police attack in Tirunelvelli. He also talked about its linkages to the
Dalit Movements and the activities regarding violence against women. When asked about
the relations of Peoples Watch with the police, he said that PW had also been carrying
out training programs for the police officers.
The Chair summarized the learning points form the presentation as follows:
> The two other methods of collecting data and building awareness ie. Fact finding
teams and Public inquests.
PUCL KARNATAKA.
Prof. Hassan Mansoor talked about PUCL and admitted that PUCL had not worked on
health because traditionally the HR model used in India has been a western one, and has
been more interested in police / state violence. He felt that the world perspective on HR
needed to include health as it is definitely a political topic. Prof. Mansoor stressed the
7
need for everyone to join hands on the issue of societal violence, which included gender,
caste and communal violence.
He talked about his work in 770 slums of Bangalore and cautioned everyone that violence
is likely to increase. He opined that unless governments were held accountable the state
might emerge as the ‘big killer’.
Replying to a question he said that PUCL was different from PUDR but both worked
together on occasions. Amar felt that HRs should not be confused with constitutional
rights. A discussion emerged on the issue of Public Interest Litigation and Prof. Mansoor
explained that the recent trend to dismiss PILs was an attempt by the Courts to curb PILs
being filed on frivolous grounds, as it was being used by middle and upper middle class
students to force changes in the failure percentage of universities rather than its intended
purpose of protecting the rights of dalits and the marginalised.
Mohan Rao also shared his experience of being party to the PIL filed in Delhi to stop the
practice of unbridled research on women under the guise of reproductive rights, and he
felt that the courts had been silent on the main demands and instead picked the least
controversial one i.e. to ban Quinacrine. Amar pointed out that Health Rights might also
be seen as political rights and GHW may heed to be aware of this if it goes into advocacy
issue. He also stressed the need for a broadening of understanding of Human Rights as an
issue.
The Chair felt that to really have an impact, health has to be understood as political and
as vital to the concept of human dignity.
SESSION III UNDERSTANDING EQUITY.
Chair Dr. Sukant Singh.
As Dr. Abel had to leave, he shared his experiences of ‘watch’ in RUHSA at CMC
Vellore, before the presentation on Equity. Abel shocked some of the audience by
announcing his finding that female infanticide may be the leading cause of IMR, not just
in the infamous districts of Salem and Madurai, but every where in Tamil Nadu. He said
that in-depth studies carried out by his health workers had revealed this, although he
admitted they had not been able to tackle the issue.
He also talked of how the meticulous record keeping and credible data base at RUHSA
had helped in changing UNICEFs prescription of Growth Monitoring as an essential
component of child health. He disclosed that his presentation in a UNICEF conference
had been behind the evaluation of the Tamil Nadu Nutrition Program (TNIP) and its
being closed because growth monitoring forms were found being fraudulently filled out
to declare a success, which he had brought to light with the help of an organized studyhe
had brought to light the fact that mothers were invariably refusing to get their child
weighed and it was not possible to monitor the growth of children because of the
traditional belief systems.
8
Abel also talked of his latest study on HIV whereby he had found that only 1% of rural
girls and 6-12% of rural boys were indulging in premarital sex. Based on this finding he
had convinced his peers that promoting condoms to the adolescent might not be useful at
all.
In the discussion that followed, Thelma pointed out that though WB and IMF gave only
marginal amounts of funds, they managed to get disproportionately large leverage in
deciding the policy and we needed to look at ourselves before we endorse
UNICEF/WHO/ or other agencies’ policies. RN informed that he had attended a WB
review meeting where he had received documents which admitted that no district has
been helped by any WB loan given for any program.
EQUITY
Dr Pankaj Mehta from Manipal Hospital in a very organized presentation tried to explain
what equity meant. He said that in simple words it could be equated to fairness. Equity
according to him meant that peoples needs rather than their social privileges guided the
distribution of opportunities for social well being. In health care, equity had to be seen in
resource allocation, services received and services that are purchased.
He felt that it was easier to define equity through its opposite, inequity, which had moral
and ethical dimensions and referred to differences that are unnecessary, avoidable, unfair
and unjust.
He reminded the participants that lack of equity is socially destabilizing and that
disregarding health equity is incompatible with long term productivity.
Pankaj displayed the various tiers at which inequity in health was apparent, starting at the
Global Level where there is a divide between North and South, and rich and poor nations,
and down to the family level where women and girl children were discriminated against.
He also talked about the causes of inequity enshrined in sociocultural customs, and
poverty, and the growing threat of globalization and liberalization increasing inequities.
He laid special emphasis on inequities faced by women from the time they are conceived
to the time they are cremated by listing out a long list of types of discrimination that
affects their health.
Ravi Narayan thought it was important not to stereotype the terms we use because
inequity is not associated with developing nations but that it is even more distressing in
the so called developed nations.
In an effort to understand the feasibility of perceiving inequity in government data the
next two presentations focused on equity in government data and programs.
Dr Ravi Kumar talked briefly about equity in National Health Programs and showed
statistics about Karnataka whereby it was apparent that inequities persist in health care.
For instance, he said that only 25% of posts for lab/ technicians in Karnataka have been
9
filled up. He also showed how cross analysis in data reveals that although all CHCs in
Karnataka have been given ultrasound machines, most CHC doctors are not trained to use
the machines or interpret their results. He also highlighted the fact that the urban health
centers had no health workers at all, as if everyone in urban centers was capable of
paying for private health care.
He said that Karnataka was spending 30% of its GDP on the social sector, which is close
to the desirable level of 40%.
Mr, As Mohammed in the last presentation of the day Mr .Mohammed of St. Johns
Medical College, explained the various types of data available with government and
equity in government health information.
He explained that Census was the only data that could supply data right upto the village
level, but it was carried out only once in ten years and the analysis was available too late.
Listing out the various data the responsible departments and the levels at which they were
carried out, Mohammed clarified the differences between Central Registration System
(CRS) and the Sample Registration System (SRS) and the Model registration System
(MRS). He stressed the need for a demand to release the data of Health Management
Information System which he informed was collated from district level upwards and
because of its regularity and continuity, he felt could be of immense use to NGOs and the
idea of GHW. He also felt that as socio-economic information is not available in any of
the systems except the decadal census, it might be impossible to desegregate data to
check socio-economic equity from available government data.
It was felt that GHW will need to demand the inclusion of Socio-economic and caste
status data.
DAY 2 OF THE GHW MEET
SESSION IV
The first session of the day was spent discussing the types of irregularities seen in India,
ways to measure them, the spheres of advocacy, roles that partners can play in a GHW
framework, organizational structure, and the relation of a National Watch with a Global
Watch. The three sub groups were given some common issues and some individual
themes for detailed discussion. The themes were based on the questionnaire that was
circulated among the participants before the meeting. The outcomes of each discussion
were used by the subgroup to modify, add to, prioritize the list of issues that had been
culled out from the responses to the questionnaire circulated before the meeting and
presented in Session VI
SESSION V
The session after the tea break was devoted to some case studies of advocacy or
campaigns carried out by leading groups related.
10
CEHAT
Amar Jesani shared the experience of 2 campaigns launched by The Center for Enquiry
into Health and Allied Themes (CEHAT), one against medical malpractice, and the other
to promote medical ethics. He said that CEHAT had identified that the private sector was
more popular and was providing the major chunk of health care because it was better than
the others in understanding people’s beliefs and cultures.
He stressed the importance of ‘negative information’ to launch a campaign, something
that he has learnt from his successful experiences. Amar said that focusing on the ills of
society by advertising or writing letters to the editor and asking people to send
information about malpractice brought a flood of letters, highlighting and filing cases of
malpractice of doctors and hospitals in the High Court also encouraged the media to take
up such cases and very soon the whole city had woken up to the cause. He said that
challenging the Government was important and one should be ready to face isolation
from medical peer groups. Amar also cautioned that it was necessary to keep good
relations with socially conscious journalists as media may often try to prevent the cases
of some hospitals catching spotlight.
Regarding the medical ethics campaign, he said that CEHAT had started the Journal Of
Medical Ethics and it was continuing for five years on subscription, which should be
considered success CEHAT had managed to get together a lobby of ethics minded
doctors who have been regularly contesting elections for the Medical Council but every
time the elections have been rigged, and this has been brought out by an inquiry also. The
participation in these various processes was in a spirit of mainstreaming the ideas of
ethical medical practise.
Amar felt that that any data churned out had to be focussed on those who were going to
use it and understand it.
Answering questions, he informed that in one of the malpractice cases filed by CEHAT’s
campaign, Mumbai High Court has decreed that patients have a right to their medical
record. During the discussions the Chair felt that the uniqueness of CEHAT’s
campaigning had been the coupling of education and awareness building (both among the
victims and perpetrators), with negative campaigning and confrontation.
PEACE
Anil Chowdhury of Popular Education and Action Center listed out the activities of his
NGO, which works through field, based organizations in the Hindi belt.
• Facilitating learning
• Supplying material continuously
• Networking to distribute information
11
•
•
Counseling within/with groups
Linking people / grassroots organizations with other specialist organizations.
To do this, PEACE has a Public Interest Research Group, which simplifies data, makes
its relevant for the reader, distributes it and helps in advocacy for policy changes. It also
does social analysis, organization building and helps in organizing campaigns.
According to Anil in order to understand anything it must have experiential basis and
should be local-specific. PEACE campaigned against the New Economic Policy and also
produces handbooks on various acts and conventions that India had signed. He stressed
the need for NGOs to be continuously updated and PEACE attempts to do this by
enabling people to generate / analyze data. PEACE’S main aim, he said, was to bring
back the culture of questioning, instead of accepting. RN said that any such training or
awareness building should be towards a questioning of the situation rather than adjusting
to circumstances. An innovative form of networking that was apparent with PEACE was
the concept of sharing infrastructure, where other groups were welcome to use
computers, stationery and skills etc., of PEACE during their campaigns, this led to
credibility and trust and solidarity and information sharing.
BELAKU TRUST
Sarswathi Ganapathy talked about her experience as a neonatologist turned social activist,
after visiting areas on the outskirts of Bangalore. Her initial visits to the rural areas had
shocked her because of the poor quality of care in the community and post-partum
practices. She talked about intramuscular Pitocin administration to mothers in labour, and
of payments that poor patients had to pay for greasing the palms of every health care
provider, leading to a very high ‘cost’ of‘free’ treatment. She, like Amar earlier, spoke of
the easy acceptability of private practice regardless of ‘quality’ due to the fact that its
practitioners treated the patients better than the generally rude governments doctors.
Her method of campaign is to talk to everyone about her indignation. This spreading of
awareness itself was enough as the collective response to her anguish showed the
possible ways ahead. Another crucial part of the Belaku experience was the openness to
learn as one went along because this was crucial as each problem was so complex that
ready made answers were never available. This, in her view has paid dividends because
she has now got the local pharmacist and the local nurse with her and with them had
formed village health fora that discuss health matters. Saraswathi wondered if these fora
could be linked to the national Health Watch to “collect’ data on how bad it is’. Another
interesting point highlighted was that not only was the quality of data available bad, but
there seems to be a subconscious filtering out of the socio-economic-cultural flavors of
the data collection and the data itself. She also noted that with the researcher lies a big
responsibility, that was not only analyzing what you have learnt but what you are going
to do about what you have learnt.
12
RN endorsed Saraswathi’s experiences and said that the corruption that she had seen and
we all see, somehow never forms a variable in research and hence escapes being analyzed
as a cause of ill health.
VIMOCHANA
Donna Fernandes gave a passionate account of Vimochana’s campaign of highlighting
the issue of homicidal killings of young brides that were being written off as accidental
deaths. She shocked many in the audience from outside Bangalore when she said that
7to8 such cases a day were being admitted to the Victoria Hospital Bums ward. And 70
to 100 of those admitted were dying every month in Bangalore. She talked about how
VIMOCHANA started by documenting all such women’s names speaking to the parents,
and using this data as a base, to get many police cases reopened. They held press
conferences and public awareness programs where VIMOCHANA highlighted the
callousness towards such a horror at every level from the filing of FIRs to the performing
of post-mortems to society as a whole. She claimed that the biggest criminals were the
professionals, a charge she substantiated with instances which VIMOCHANA had found,
where doctors had taken money for a false post-mortem, and police had taken a portion of
the dowry for the price of their silence, showing the depth to which they could stoop.
The VIMOCHANA campaign also included a public TRUTH COMMISSION and its
efforts paid off when the police commissioner was hauled up to the floor of the
legislative assembly and censured by the legislative house committee.
Despite this, Donna felt that it was important to sensitize the police, a task
VIMOCHANA is carrying out. Its efforts had also led to the drastic improvement of the
condition of the once horrific bums ward.
The meat of her narration was her statement that 7Z would not be enough to be a
watchdog; GHW would have to be a barking dog to be effective. However one cannot
bark if one is not watching, ”
DEPARTMENT OF SOCIAL MEDICINE AND COMMUNITY HEALTH.
JA WAHARLAL NEHRU UNIVERSITY
Dr. Mohan Rao from JNU shared his experience about the Quinacrine campaign in which
he and the faculty of the School Of Social Medicine and Community Health had
launched.
He started by providing a background about China’s entry into the WHO in 1978
coinciding with the Alma Ata Conference and how it had successfully raised its life
expectancy of 22 years to 62 years in a matter of just 30 years. He also talked about the
decline of the role of WHO and the rise of WB’s importance on health since the late
eighties.
13
Terming RCH as a now acceptable term for Family Planning, he was worried the ‘target
free’ would be translated to ‘responsibility free’ as already shown during the quinacrine
scandal. He detailed the abuse of Quinacrine that was being used by a Calcutta
gynecologist running an NGO as a research project for permanent sterilization of women
despite ICMR having failed at it and WHO’s strong views against it. Couched in
language of ‘women’s empowerment’, the research had incensed various sections of
society and as individual members, many of the faculty of JNU and the women’s groups
out of the many backing the campaign, had filed a Public Interest Litigation. The PIL
sought to highlight,
> The issues of accountability of NGOs / voluntary organizations
> Punishment for doctors involved in such practices
> ICMR to trace the thousands of recipients of such corrupt practices and compensation
given as in Bhopal.
> Need for a system to monitor the Public Health Action and research.
However in a shockingly superficial judgement, the court had trivialized the matter by
merely banning quinacrine and closing the case. Mohan Rao tried to highlight how even
well planned activism can miss the target once you get entangled with the tangles of
bureaucracy and judiciary.
PEOPLES SCIENCE MO VEMENTS
Dr Sundar Raman talked about this Peoples Organisation and said that its main aim was
to question the scientific profession and acheivements. Because of the fact that the
scientific professionals and their work had not benefited the poor and the marginalised,
Peoples Science Movements (PSM) had attempted to raise people’s consciousness about
this fact in an effort to make Science and Technology more relevant to the needs of the
majority. For anyone trying to do this, he felt that one needed
• Public awareness
• Possibility of organized action by people
• A place on the political agenda.
Sundar said that any campaign needed about 2% outreach to remain visible as a
movement, more than 20% to make an impact, but to effect a change, one needed to
reach out to at least 50% of the people.
PSM has also been making advocacy campaigns of which the main is
• Demands on the state for policy change and state intervention making the state pro
masses in letter and spirit and action
• Demand on medical profession to sensitize them on existing inequalities, their role in
its continuance and their responsibility.
• Demand on the people culturally and educationally making them more aware of their
rights and duties.
• Demand on PRIs to make health and local appropriate development part of their
agendas.
Position: 1276 (4 views)