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[afro-nets] Counter Austerity! Vote for Bottom-Up Democracy in Health
- From: "Celina & Case" <firstname.lastname@example.org>
- Date: Wed, 22 Jun 2011 14:29:32 +0200
The time has come to invite the millions of people living with life-threatening diseases to join the movement for the Right to Health. Yet, surprisingly, there is some opposition to this invitation.
Within many Global Health 'silos' - the individual disease programs such as TB, HIV, and Malaria, a handful of civil society organizations have succeeded in gaining a place at the board table of the policy makers. In other 'silos', including those of the non-communicable diseases, the handful is actually just a finger-full, and participation is far too limited to the mega multi-national NGOs. They all speak of 'community' and of the 'voices of those in need', and often bring selected photogenic patients to meetings to make their demands for still more resources 'look good', but this is not meaningful involvement.
In some of the global health institutions (WHO, UNAIDS, UNITAID, Stop TB Partnership, etc) 'delegations' have been established and run by big NGOs, with 'representatives' selected by the inner-circle. Little if any effort has been made to open the system of representation up to wider participation, and many have resisted attempts to do so. Gatekeepers assure that mostly the same usual suspects can attend high level meetings, and they often 'represent' people living with the diseases in several institutions - but without any real mandate. This also assures that the genuine and unfiltered voices of people with 'serious' diseases are not heard, and that they can't participate in the decisions that may be of life or death importance to them. Although there are some very good and sincere people involved, the systems of representation are exclusive, and institutionalize elitism and nepotism. Conflicts of interest are hidden from view, and the lack of civil society accountability is a green light to governments to allow corruption to go unchecked on the ground. With no watch-dogs on the streets, those above can 'alley-cat' without fear.
The coming years of hard times for health financing will impact hardest on those at the bottom - poor sick people in hundreds of thousands of districts around the world. Too many suffer and die needlessly already due to lack of access to basic essential medicines and care, and the projections for the future are deathly dreadful. Clearly, urgent action is needed to mobilize a greater participation in health issues from more of the population, and to harness these human resources to bring pressure on governments and global institutions to keep promises, deliver better services and to increase their support for the Right to Health for all, the underlying obligation of all governments that are members of the United Nations, and all organizations working in health. The present system of unaccountable representation must be reformed.
Recent advances in mobile technology and social media now allow for greater participation via SMS (FrontlineSMS for example) and simple messaging across social networks in any language. Twitter, for example, can be used on any non-smart phone in many low income countries, enabling almost anyone to learn more and to 'have a say'. A growing number of innovative 'mobile-activists' around the globe have been developing systems for SMS based information exchanges and even voting in referendums on local issues. m4HealthDev projects and products, by and for the community, are gaining ground each day, and now need to be scaled-up and replicated.
Today, some sixty million very poor people are sick and suffering, and must be allowed to participate in decisions that are about them. Democracy is a great tool for accountability and transparency, and is now the key tool for mobilizing widely so that 'austerity' isn't fatal to many millions already at risk. The time is now to begin the process of developing mPowered patients, who can build their own systems of democratic representation, from the bottom-up. Now, we must demand that those in power act to reform bad practices, and support the march for the Right to Health by the voiceless. From the bottom to the top - the short message is "Democracy Now!"
Celina & Case, Coordinators
IMAXI Cooperative Trust (Kerala, IN)