Report for Saturday 15 March (Day One)

Day One Report
Day One Schedule
Welcomes and housekeeping
We were a bit slow to start (breakfast was a bit delayed and some of us were still arriving) but by 9.00 am we were seated, a bit apprehensive but ready to go.
Narendra Gupta welcomed us and we then introduced ourselves. Diverse backgrounds and rich experiences. Narendra and Tej Ram Jat then took us through the housekeeping and David Legge introduced the program. These preliminaries took us to tea time.

Host Home

Globalisation and Health
After tea David Legge presented an overview of Globalisation and Health. He commenced with a broad summary of the global economy since the end of the WWII. He divided this period into (i) the long boom’ from 1950s to 1970s; (ii) stagflation in the late 1970s; (iii) slower growth (the over hanging crisis of over-production (since then); (iv) the 2008 credit crisis. He then went through the same period again focusing this time on some key events in global economic governance and global health history, demonstrating how closely linked these two stories have been. David ended up by drawing some lessons for strategy (for PHM) from the story he had been telling.
Reports from the field
We returned after lunch to the first of our Reports from the Field sessions. Thelma Narayan facilitated this session.
Omesh Bharti told us two stories. He commenced with some comments on vaccination policy in India. Despite the fact that many districts in India have very low vaccination rates with the basic vaccines, GAVI and WHO and the WB are pushing new and expensive vaccines onto India. He argued that it is hard to justify compulsory Hep B vaccination and the diversion of resources into polio eradication when some districts have vaccination rates as low as 8-10% and around 300 centres have no staff at all for want of staff salaries. JSA will fight these policies in the courts. More details here.
The second story Omesh told was a case study of substandard pharmaceutical formulations. At a time when JSA is arguing that doctors should prescribe generics the existence of inefficiency and even corruption in the inspection and regulation of the medicines market (including generic medicines) provides some grounds for those who argue for brand name prescribing. The story he told involved identifying the problem serendipitously and then lobbying and local media publicity until the government agreed to take action. The miscreant is now behind bars.
We had a rich discussion of the lessons emerging from this story. Most of our discussion focused on how to move from an individual case such as this one to a more systemically focused fand movement building approach. One possible framework for institutionalising work on this topic would be the community based monitoring component of the NRHM. In Karnataka JSA is involved in community based monitoring, at various levels from village to state with authority to come out with reports. The focus of the local monitoring could be on local stocks and drug supply but at the higher level the focus might be on drug quality.
Sanjay Kumar Singh then offered us a case study that is used in promoting awareness of family planning. It is a story about a young man who commits suicide, at least partly because he cannot meet the needs of his large family. Perhaps if he had been more aware of birth control he might have not me this end.
We had a rich discussion following this story focused largely on the importance of understanding the complexity of the determinants of rural poverty and of addressing the structural issues which frame rural poverty and suicide.
Jyoti Gupta then told a women’s reproductive health story involving working with dalits and excluded people on MMR and MDGs. The challenge was to highlight the seriousness of high MMRs. They used a documentary of 20 mins. No one responded to it; no one said a word initially but they were gradually coming to grips with the magnitude of the problem.
We returned to the structural and system issue which set the context in which the suicide may have taken place. How to use this same story to focus attention on these larger structural issues? We discussed the use of stakeholder analysis and participatory vulnerability analysis. Who are the stakeholders; what are the vulnerabilities?
We ended up with some comments about the importance of not creatine unnecessary contradictions between the immediate needs and the longer term project of structural change. We need to work on both. This brought us to afternoon tea.
Small Group Work
We then had a somewhat chaotic session deciding how to organise our group work. We identified a number of potential theme areas and then selected six of these for more focused work. These groups are:

• Rights approach to health
• Trade and health (perhaps including access to medicines and GATS
• Family planning, reproductive health and foeticide
• Tribal peoples: health and health care
• Community participation in health and health care (including health education for PRIs

We then dispersed into our groups.
To be continued.
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