Learning together: program and activities

•  the struggle for health: concepts (eg theories of change, forms of action), strategies, methods and skills in practice (eg working across difference);
  
• primary health care and health systems;
  
• political economy of health (includes globalisation, international institutions, etc);
  
• the social determinants of health;
  
• health and the environmental struggle;
  
• the right to health;
  
• social change and forms of action
  
• research for people’s health;
  
• spirit, meaning and ethics; and
  
• communications and information technology, including social media.
  

See the IPHU Library. 

1. Start with PHM and the People’s Charter for Health (and the Mumbai & Cuenca Declarations). We need to start with an introduction to the PHM and the Charter. This helps people to orient themselves around the course content and in particular the group work. We need a good presentation about PHM, including our history but also enough time to absorb structures and processes of PHM. A way to approach the Charter is first, to ask people to read the Charter and answer some basic questions before arriving, and second set up small group discussions of the Charter as part of Day 1, asking participants to identify that which seems useful and that which might need to be revisited.

2. Learn about local issues and circumstances from the different regions and countries represented. We are always very interested to hear about health issues, health system arrangements, hot topics in health policy from all of the countries.  In recent courses we have asked participants from different countries to get together before the course or on the first day or so to prepare posters highlighting the key features and issues from their countries. This will include the host country but we will also learn more about the local issues from our field trips.

3. Introduction to ICT (see Library page). This needs an introductory session early in the course and then a number of practical exercises to be undertaken during the course corresponding to people's existing IT level with presentations (or whatever) at the end of the course. Might not be feasible in relatively short courses.

4. We have three topics which set the immediate context in which to consider people's health issues. These are:

• social determinants
  
• health systems focusing on primary health care
  
• environment (climate, water, food, work, etc) 
  

These are all topics which need some factual input but also need to bring in ‘stories from practice’.  In recent courses we have asked resource people to present a background (theoretical and political) plus a ‘framework for action’ in this particular area and to invite one participant to present a case study which can be discussed in relation to this framework for action. One prepared case study but limit the time allocation with space for volunteered stories from the field.  We need to ensure a strong focus on practical engagement in this area.

5. We then have a series of topics dealing with the macro environment:

• globalisation
• health systems policies and health care financing
• trade and health
• foreign aid and health (including discourses of ‘development’)
• food

Some of these can be addressed in a relatively informal way through reports from practice followed by discussion.  Others require more factual input.

6. We then have a series of topics which are more focused on activist practice and strategy:

• human rights and the right to health
  
• working across difference (gender, race, class, caste, etc)
  
• social change and forms of action
  
• meaning and spirit
  
• research
  

Most of these topics can be addressed through ‘reports from practice’ with ‘expert input’ presented in a relatively informal way.

Each topic (represented as a page in the Library) includes (or
should include):

• background or introduction
  
• learning objectives
  
• PPT, PDFs and URLs
  
• class exercises as appropriate
  
• assignment for assessment (for students looking for accreditation)
  

Pedagogy

Clear articulation of our pedagogical principles in the briefings for resource people and participants is therefore essential.  General pedagogical principles (work in progress - comment welcome) include:

• partnership in teaching and learning (co-production of knowledge); respect for what the participants bring and provision for all of us to learn from each other; 
  
• facts and concepts presented (or accessed in some other medium) need to be used for practical purposes (students must speak/use the new ideas if they are to internalise them);
  
• the practice of political engagement involves new ways of using our bodies (new methods and skills) as well as new facts and concepts; calls for opportunities to try out new methods and skills in a safe place (or to identify new methods and skills (as modelled by others) that we will be able to try out later); eg overcoming self-consciousness;
  
• becoming an activist is an ethical project; we create the space, motivation and rituals in which we can all deepen our commitment; including work on our own barriers and obstacles (prejudices, individualist ambitions, etc);
  
• movement building involves developing personal relationships which bind the movement together; respect for the different roles and contributions but appreciation of their complementarity and trust that others are supporting them; movement building is about relationships; 
  
• the learning during the course is just one episode in a journey of life long learning; we need to support expectations of continuing learning including through participatory action research;
  
• training the trainers, we want our participants to further develop their own skills and insights about movement building so that they will support further learning and group work in their own networks;
  
• leadership; calls for knowledge, experience and judgement; calls for communication skills (listening as well as inspiring) and also calls for courage and willingness to take risks (when action is called for in situations of uncertainty); these are partly about developing skills but they are partly an ethical project - becoming someone who can project leadership when necessary;
  
• questioning and research; activist practice draws on facts and on frameworks (descriptive, explanatory, predictive, prescriptive); our facts and our frameworks are always inadequate for the complexity of the situations in which we work; we must constantly test our facts and frameworks against our experience; sticking dogmatically to particular formulations can be a reflection of our own psychic needs rather than the timelessness of those formulations; learning to see uncertainty is an important part of our objectives; learning to reduce uncertainty is in part about learning research skills (particularly participatory action research principles).
  

Different topics call for different approaches to teaching and learning. Some topics, for example, trade and health or globalisation may require a fairly content rich presentation linked with stories from practice. Other topics such as the right to health, social determinants, environment and health, etc may be better approached with case studies from among the participants followed by small group and plenary discussion. 

Pre-reading and writing

We have repeatedly discussed the possibility of participants undertaking preparatory work before attending the IPHU.  See for example the pre-course questionnaire and ">pre-course writing exercise.  These are online forms which download to spreadsheets.  Less ambitiously, in some courses we have asked participants to read some basic material about PHM including the Charter (here).  

In fact, participants have found it quite hard to do much reading before courses, particularly when there is not much time between acceptance and commencement. 

Activities

The various learning activities that have been found useful include:

• ice-breakers: aerobics, tai chi, telephone tree, ball messages, etc etc;
  
• lecture discussions (plenary presentations followed by plenary discussion; good for some topics, such as global political economy of health but not always so good for learning the methods and skills of practice);
  
• case studies of practice (participant presentations of episodes from their own work); followed by plenary discussion about strategy and practice);
  
• panel discussions (plenary sessions; several resource people; one facilitator; questions collected in writing in advance (post dedicated notice paper); good for delving into controversies by having people with different experiences and perspectives engage in relation to uncertain or controversial areas, eg the dynamics of social change);
  
• role plays (eg for exploration of ‘working across difference’);
  
• group work: project groups and country groups; see below;
  
• unstructured time for informal communications and friendship, including meals and social events;
  
• excursions to local agencies or field trips where relevant;
  
• concluding ceremony (including certificates etc).
  

Group work is an essential part of the program. It provides a space for participants to try out new ideas, reflect upon the plenary sessions, share experiences and build new friendships.  However, while the agenda for the group work is broad and flexible the core agenda item is about the struggle for health and building the people’s health movement.

As a general plan we aim for around 3 project group meetings and 2-3 country (or provincial) group meetings.

It is time-saving and works reasonably well to present to the class a list of possible project group topics and invite them to self-select; eg:

• Comprehensive PHC
  
• Health systems (eg human resources for health, access to medicines)
  
• Maternal and child health
  
• Social determinants (eg food and nutrition, environment)
  
• Trade and health (eg impact on agriculture, access to medicines, human resources)
• AIDS/HIV, 
• RTH and planning for PHA4 are cross cutting issues.

Thus we have participants from a mix of countries working on one of these topics and reflecting on activist projects which might involve international links and shared resources. 

Then we have the country / state or provincial groups come together to think about PHM building and an agenda for action in their country or region.

On the final day we have presentations from both sets of groups.

Schedule

We have a generic course planning model (here) which may help in planning the program for the course.

We have the beginnings of a resource collection, including lectures (as Powerpoint presentations), electronic resources (mainly as PDF files) and hyperlinks.  We have many gaps and weaknesses in this resource collection. The resource collection is stored online.  (At this stage we do not have a secure (password protected) pdf storage site which (for copyright reasons) limits our ability to post resources.  They may be available on request by email.)

The People’s Charter for Health and Global Health Watch (1-5) are core resources.

We have some resources on the core topics (and some on more specific topics) but they need improving and developing. Will depend on faculty.

The course coordinating group for each course needs to identify early what lecture /presentations will be scheduled and to ensure that the relevant resource persons understand that their role includes finalising their topics early for posting well before the participants leave home (has never happened yet).

The lead up to new courses is the most promising time to get people to work on upgrading our resources so we need to identify our faculty as soon as possible and negotiate topics and areas of responsibility with them.  

Multilingual courses

Multilingual courses are very rich in terms of making new links and learning about other cultures.  However, they require good simultaneous translation which can be burdensome on volunteers and expensive in terms of professionals.  Further the time taken on translation reduces the time for substantive engagement.  

Class Committee

We need a class committee that meets each night to reflect upon how well the day went and draw out any learnings and to preview the program for tomorrow and discuss the final details about how different sessions might be run.

The core membership of the Class Committee includes all of the facilitators (see above), the core faculty and representatives from each of the project groups and country groups (if relevant).  However, meetings are open to all.

Please note: at the end of a long day it is very hard to mobilise the energy to return to work. For this reason we need an identified volunteer who undertakes to ensure that this class committee convenes!

Personnel and roles

It is useful to identify the different roles that are involved in presenting an IPHU course.  These include: 

• organisers
• anchor person
• resource persons
• facilitators
• participant volunteers 

Organisers

We have often needed two organisers, one of whom works from the beginning as part of the course planning team and the other who is locally based and can handle local logistics.

The organiser has principal responsibility for logistics before during and after the course.  Reference to our logistics planning page (here) demonstrates that this is a critical role.

Anchor person

It has proven useful in previous courses to have one person to take responsibility for over all leadership, including in course design, selection of participants, recruitment of faculty and direction of course activities.  Clearly this function is carried out in close association and consultation with a wider leadership network.  

Resource persons

We have generally mixed local faculty with international faculty.  This has proved rich.

We value particularly those faculty members who are willing to stay for the full course.  It is very difficult for fly in fly out experts to orient their presentation to the objectives of the course, the expectations of the course participants and the emerging culture of the group.

It is also important to invite alumni from previous courses. It adds greatly to the course experience to have previous alumni participating (both as presenters and as facilitators).

Facilitators

In recent courses we have engaged 5-7 facilitators to work with the project groups and
to carry some of the identified responsibilities (see above).

These facilitators should be alumni of previous IPHU courses so that they can give
appropriate guidance from Day 1. 

The facilitators are the core members of the Nightly Program Committee (because
they are present for the whole course) and because they are closely in touch
with the participants.

We need to schedule a half day workshop involving at least the ‘anchor person’ and the facilitators before the course starts to ensure that everyone is fully briefed and loose ends are tied. Likewise we need to schedule a final wrap up discussion involving, at least, these same folk, to review the course and document the lessons from the course. 

Identified volunteer roles

We need volunteers from among the faculty, facilitators and participants for the following
roles. These are not mandatory but illustrate how previous courses have worked.

1. Documentation collective – collects stuff for the take-home flash drive and copies material to the flash drives.  Need to include presentations, photographs, project group reports, feedback and evaluation reports, etc etc. 

2. Morning feedback organiser – ensures there is a group to provide feedback from yesterday each
morning.  Note that the purpose of the feedback is NOT to recapitulate boringly everything we did yesterday.  Rather it is to rework some of the key themes from yesterday in various creative ways (poems, songs, street theatre,
etc).  

3. Social and cultural facilitator – to work with the social and cultural committee to provide social and cultural events, including for the evenings. 

4. Case study identifier, collector and coach. We need one of our facilitators to take responsibility for selecting (in consultation with presenters) participants to prepare case studies for different sessions and to work with them to prepare their case studies. 

5. Day by day feedback poster. We need a poster for each day which shows the program and includes space for ticks under different emoticons alongside each event (see Smileys template). To
collect immediate feedback.

6. Convenor of nightly meetings of Program Committee (make sure it happens).  This is an open meeting and all participants
are welcome. However, we need to have a representative from each project group who is expected to attend all of the nightly Program Committee discussions. Program Committee includes anchor person, facilitators, lead faculty members, local team
organiser as well as representatives from each project group. 

We need

• feedback on this page; what is missing; is it too long; how to make it more useful?