Report for Sunday 16 March (Day Two)

Day Two Report
(Day Two Schedule)

Feedback for day one

David asked for feedback on the proceedings of the first day of the workshop. There were some issues related to logistics and the lack of clarity on roles of class committee that were solved right away.

The session on globalization was very informative and experience sharing useful; but not everyone felt involved as not everyone got a chance to share their experiences. Other comments were – need to know more about PHM / JSA.

The Peoples Health Movement

Dr. Thelma Narayan, starting with how social movements are built and their importance in building a public discourse for policy change, talked about the evolution of Peoples Health Movement and how it developed into a global campaign. She thus gave a brief on how the National Health Assemblies took place and the People’s Charter was formulated; also how JSA works in India and was engaged in dialogues with the government in giving shape to the NRHM.

She also talked about various challenges these movements face when various groups come together and their dynamics are challenged and professionalism gets questioned.

She said that all of us have various skills that are required for building these movements but what is required is the perspective for an analytical understanding of the health situation and its determinants.

This session was followed by a tea break that was subsequently followed by a Quiz scoring a ‘yellow signal’ for the participants indicating that they were prepared to go ahead with further lessons!

Social determinants and PHC

Dr. Narendra Gupta asked the participants to list down the social determinants of health; which turned out to be a long list and showed the complexity of the issues involved. Taking all the points together the participants tried to categorize the determinants into following broad segments in term of priority and importance. This process started with a question - what make people fall sick and following points derived:

• Lack of access to safe drinking water -water having no physical, biological and chemical impurity
• Lack of access to food-a balanced food for all individual
• Sanitation-Housing, drainage system for solid waste and liquid waste management, access to secured and safe housing

Getting into the point on population as a determinant of health as suggested by one of the participants, there was lot of debate if population is a problem. The group was divided on the issue if population is actually the major problem for poverty and lack of access to food, education and other entitlements. The discussion thus went into greater detail as it was considered necessary for having the right perspective.

Thus, the issue of son preference was also brought up. Sex selective abortion contributes to in population imbalance, but it is the rich, educated and urban families who go more for sex determinants than poor, uneducated and rural families. Availability of contraception only does not determine the population size.

LUNCH BREAK

Equity in Health

In the later half of the day Dr. Armando made a presentation on equity in health. He explained the concept of equity in heath, ways to analyze and measure inequalities. In his introduction he asked - do equity matter in health, if so can equity be a leader concept in right to health? He said equity is an ethical issue and must be dealt with zero indifference and it is the best possible approach for achieving equality. He explained in detail the historical evolution of the concept over time – in various political and ideological debates.

He said that the importance of equity analysis lies in the fact that it explains the equilibrium of different determinants, in coherence with the multi-dimentionality of rights and the complex reality of the situations. It thus helps to revive the rights approach through a political explanation with real inclusion of people in the analysis.

Peoples Charter for Health

The groups that were formed the previous day again got together to discuss and review the People’s Charter on Health. The questions for the review were - How useful is the charter? How could it be made more useful? And what is missing?

After half an hour of group work, following suggestions came up, to have"
Preamble
1) The term globalization need to be defined or instead just use the term ‘neo-liberalism’
Principles
1) The service provider must be made accountable
2) Good governance must be included
Health as a Human right
1) health as a human right should defined to have clear overview
2) along with right to work, ‘right to equal wages’ must also be added
Tackling broader determinants of Health
1) we must add the demand for health care provisions for the displaced communities
2) Demand for common education system
People-centred health policy
1) Health and drug policies be present at state level
People’s participation
1) Emphasis be placed on ways to empower communities to enhance their capacities in engaging with various processes that improve their access to better health. That is, people should come before the people’s organization.
2) Add the word ‘initiate’ (innovate) in the second point, before ‘promote, support and engage’.

At the end David Leege shared that each thought / idea on the People’s Health Charter needs explained and understood well.

Photos

IPHU at Jaipur

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