Civil society engagement in the struggle for Health for All

Civil society engagement in the struggle for Health for All

Between 2014-2018 People’s Health Movement undertook a large multi-centre study exploring civil society engagement in the struggle for ‘health for all’.

The study was funded by the Canadian International Development Research Center (IDRC).

Over four years, 130 researchers in 10 countries produced 50 research reports.

The final report of this research is here.  A separate short version of the final report is here.

A peper entitled ‘Methodological challenges in researching activism in action” by Chiara Bodini, Fran Baum, Ronald Labonté, David Legge, David Sanders & Amit Sengupta is published in Critical Public Health. To link to this article: https://doi.org/10.1080/09581596.2019.1650892. A close to final version of this paper can be downloaded here.

This page serves as the index page linking the separate research reports produced by the research groups in the six participating countries and reports from various other regional meetings and globally produced research studies.

New publication: A special supplement of the Brazilian journal Saúde em Debate was published in January 2020, focusing on the work of the People’s Health Movement (PHM). Several articles originate from this research:

  • Colombia
    • [pag. 51] Struggles for the right to health in Colombia. Links with health for all. Mauricio Torres-Tovar, Román Rafael Vega-Romero, Jairo Ernesto Luna-García, Yadira Eugenia Borrero-Ramírez, María Esperanza Echeverry-López
    • [pag. 79] Indigenous struggles for an own and intercultural fundamental right to health in Colombia. Jaime Hernán Urrego-Rodríguez
  • Brazil
    • [pag. 64] The school as a space for social participation and citizenship promotion: the experience of building participation in a school environment. Camila Giugliani, Katia Teresa Cesa, Eliane Maria Teixeira Leite Flores, Vânia Roseli de Mello, Patrícia Genro Robinson
    • [pag. 183] Life, struggle and People’s Health Movement in Brazil: interview with Sister Anne WhibeyMarta Giane Machado Torres, Átila Augusto Cordeiro Pereira, Tânia Sena Conceição, Valdirene Barroso Miranda, William Dias Borges
  • Italy: [pag. 91] The transformative potential of health as a commons. Chiara Francesca Bodini,Giulia Bonanno, Elisa Cennamo, Bruna Mura, Martina Riccio, Lorenza Santoro
  • El Salvador: [pag. 171] Universidad Internacional para la Salud de los Pueblos 2011 – 2018. Los Cursos Uisp en El Salvador, una experiencia transformadora International People’s Health University 2011 – 2018. The IPHU Courses in El Salvador, a transformative experienceMaria Elizabeth Hamlin Zúniga

Country projects

Brazil

In Brazil three separate sub projects were undertaken:

Colombia

Stage 1 of the Colombia project comprised nine case studies of civil society engagement in health development.

  1. Asociación de Cabildos Indígenas del Norte – Association of Indigenous Councils of the North (ACIN)
  2. Asociación Campesina del Valle del Rio Cimitarra – Peasant’s Association of Valle del Rio Cimitarra (ACVC)
  3. Association Of Extrabajadores Enfermosof Colmotors – Association of Sick Former Employees of Colmotores (ASOTRECOL)
  4. Escuela Popular de Salud – People’s School of Health (EPLS)
  5. LGBT in Cali,
  6. Movimiento Nacional por la Salud y la Seguridad Social – National Health and Social Security Movement (MNSSS)
  7. Asociación Campesina del Valle del Rio Cimitarra – Peasant’s Association of Valle del Rio Cimitarra (ACVC women’s direction)
  8. Zona de Reserva Campesina del Valle del Rio Cimitarra – Peasant Reserve Zone of the Cimitarra River Valley (ZRC), and
  9. Trabajadores del Hospital San Juan de Dios – Workers of San Juan de Dios Hospital (HSJ).

The summary Stage 1 report (report here: ES, EN) includes reflections on the implications of Stage 1 findings for the five central themes of this research.

The Stage 2 research commenced with a review and planning workshop (report here: ES, EN-G) leading to a new Stage 2 capacity building pilot project (proposal: ES, EN-G).

Reports of three preliminary consultations regarding implementation of the proposal are here:

  1. ZVTN Juan Carlos Castañeda, Carrizal-Antioquia during the days 2 to 4 of July of 2017: report: ES.
  2. Lejanías-Antioquia, on July 5 and 6, 2017: report: ES;
  3. Three communities around La Macarena-Meta: ZVTN Urías Rondòn (July 2), Vereda La Cristalina (July 3), and Vereda Playa Rica (July 4): report: ES.

The interim Stage 2 summary report is here: ES, EN-G.

New publication from Colombia team:

Torres-Tovar, M. and J. E. Luna-García (2019). “Struggles for the right to health at work in Colombia: The case of associations of workers with work-related illnesses.” Global Public Health 14(6-7): 996-1007.

Democratic Republic of the Congo

In DRC an interview study was undertaken with a view to eliciting experiences and opinions from civil society organizations regarding each of the five domains (report here).  A further workshop and IPHU was held in April 2018 (report here).

India

The India group elected to undertake a substantive review of the Indian experience in relation to the five generic themes deploying literature review, document analysis, key informant interviews and case study documentation and analysis.  The group elected not to include an action research component into their research but to focus on a formative evaluation of Indian experience.  See India report, Methodology, from p. 4.

The literature review of social movements and the Health for All movement in India (India report, from p. 7) provides a rich coverage of the theoretical discussions of social movements in India and an overview of the ‘movement for health’ in India.  The material in this literature review has informed the empirical theme-focused research including the selection of case studies.  This literature review also complements the literature review presented in Annex 7 of the main report.

The empirical research undertaken for the India study is reported under each of the five themes.  The findings and commentary are extensive and rich and need to be read in the original.  These sections are drawn upon in the thematic chapters of the main report.

Italy

The research in Italy was undertaken through a network of young health activists which has been meeting since 2006 and comprising medical students, medical graduates, public health professionals and others.  Many of PHM’s Italian activists have been members of this network and have participated in its meetings. For the purposes of this research the volunteer researchers constituted themselves as “Grup-pa” (permanently open group).  The research collective included people from different cities in Italy and the mode of communications and collaboration included face to face meetings, Skype meetings, and various forms of digital collaboration.

The first phase of the research is reported here (IT, EN, *32 MB; EN-lite, 1 MB)  The research collective decided to focus on the social determination of population health rather than on activism around health care. For the purposes of defining their fields of work and undertaking (and transcribing) interviews the volunteers organized themselves into nine working groups.  Seven of these (Education and disability; Environment, health, work; Land and food sovereignty; Imposed mega projects; Queer; Arts and culture; Alternative economy) undertook interviews with key informants in civil society organizations and networks centred on these different fields of work.

The interview transcripts were reviewed in small groups and analysed in accordance with the five project themes. In a second round analysis a series of ‘conceptual maps’ were developed structured around a further set of seven topics: Structural context; Non-identitary processes; Organization and functioning; Sustainability; Training and education; Direct action; and Interaction.  Further analysis of the findings was undertaken in relation to these topics which were notionally mapped to the five project themes.

In their study of Campaigns the research team documented twelve health-related campaigns in Italy, largely from the last decade.

  1. Due Sì per l’Acqua Bene Comune (“Two ‘yes’ for water as a commons”)
  2. Citizens’ initiative for a law on water as a commons
  3. deLIBERIAMO Roma (petition supporting four initiatives concerning water, finance, schooling and urban spaces)
  4. Access to land
  5. Terra Bene Comune – TerrABC (“Land as a commons”)
  6. Citizens’ initiative for a law on a guaranteed minimum income
  7. Stop TTIP
  8. Sbilanciamoci! (alternative economic and development policies)
  9. Noi non segnaliamo! (“we will not report”) (resisting requirement for health care practitioners to report unauthorised migrants needing health care)
  10. No Alaco (opposing the Alaco dam)
  11. Yo decido – El tren de la libertad (I decide – The train of freedom) (opposition to Spanish anti-abortion legislation)
  12. Gender strike (supporting the struggles of queer movements and of precarious workers, students, unemployed, migrants, etc)

Two of these (#9 and #1, above) were selected for more detailed case studies.

The working group on Critical medicine prepared a brief history of Critical medicine in Italy (and Europe more broadly) and sponsored a two day workshop on ‘Health and social movements: 1978-2015’ in Bologna in April 2015.  A key feature of this meeting was hearing the personal narratives of the people who had lived the years of the critical medicine and healthcare reform movement. The different experiences came together in a collective narrative, but a very heterogeneous one and rich of diversity. The personal motivations of those involved were also shared and discussed.

At the end of the first stage of the project the research collective formulated three priorities:

  • to repoliticise the discourse on health, challenging the hegemonic biomedical perspective while proposing different approaches (“what is health?”);
  • to share, experiment and put into practice different ways to “make health”, taking into account also the aspects of decision-making, organization, sustainability (“what makes health, and how?”); and
  • to promote and sustain the process of building a movement for health in Italy.

The group decided, for the second stage of the project (here: IT, EN), to organize three open workshops focusing on three key issues emerging from the project.  The organization of these three workshops constituted the main focus of the second stage of the project.

The second stage report provides brief summaries of the discussion at the workshops (and links to the video reports) but the main focus of the report is a reflection on the research experience across the two stages of the research. This summative overview includes reflections on the five (main) project themes, constructed largely around the experience of the research collective during the first and second stages of the research.

South Africa

The South African contribution to the CSE4HFA was coordinated by the People’s Health Movement South Africa (PHM SA) Steering Group. The research activities was carried out by PHM members supported by two professional researchers.

The key events around which the South African projects have been implemented are as follows:

  • November 2014. PHM SA held a planning workshop to align the research with PHM SA’s priorities and commence planning for Stage 1 activities;
  • December 2014. South African People’s Health University (SAPHU) course;
  • June 2016. Africa CSE4HFA Regional Workshop (see Countries Regional Workshops 2016) Aug 2016;
  • June 2016. 2016 SAPHU (focused on community health workers or CHWs);
  • June 24-6 2016. National Health Assembly (NHA, see description in SA Stage 2 report); and
  • July 2017. Day 1. Consultative workshop with NHA partners. Day 2. PHM-SA Reflections and planning workshop (see Report of workshop findings and decisions in SA Stage 2 Report)

The main streams of health activism which have been addressed by the South African team include:

  • PHM’s Right to Health (RTH) project, from 2007;
  • The National Health Insurance (NHI) Campaign (from 2010), co-sponsored by PHM-SA, TAC and Section 27;
  • SPHUs in 2014, 2016 and 2017 (two courses);
  • SA NHA in June 2016 and campaign proposals emerging:
    • Community Health Workers: The foundation of primary health care
    • Clinic Health Committees: One clinic – One committee – One policy
    • Health Financing and Tax Justice: Stop subsidising the private health sector
    • Stop Stock-Outs: Medicines when we need them
    • Human Resources for Better Health: People make the health system

Five studies were undertaken as part of the Stage 1 Research (see South Africa Stage 1 Report):

  • SA RTH Campaign. Reflections on the PHM-SA’s RTH Campaign (see Stage 1 Report);
  • NHI Campaign Reflections. Reflections on the NHI Campaign, co-sponsored with Section 27, TAC, and others from 2010 (see report: South Africa NHI Campaign Case Study);
  • SAPHU Evaluation. Formal evaluation of the 2013 and 2014 South African People’s Health University (SAPHU) (See report, dated 17 May 2016: South Africa SAPHU Evaluation);
  • CHW study. Health activism, mobilisation and organization among community health workers (see report dated May 2016, South Africa CHW Case Study); and
  • Overview history of civil society engagement in health development in South Africa (included in the body of the Stage 1 report (South Africa Phase 1 Report), from page 1).

The main study undertaken as part of the second stage was based on a two day workshop held in July 2017. This workshop involved PHM researchers and members, several SPHU alumni and representatives of some of PHM’s main partners in the 2016 National Health Assembly.  The workshop provided an opportunity to reflect on the experience of the projects addressed through the CSE4HFA research, the implications for the five generic themes, and lessons for the future.  The report of the workshop forms part of the Stage 2 Report (South Africa Phase 2 Report).

In both the South Africa Phase 1 Report (from page 10) and the South Africa Phase 2 Report (from page 15) there are extended sections where the South African team have drawn out the implications of their research for the five generic themes.  These passages have informed the analyses presented in the relevant chapters of this final report

Regional discussions

Regional discussions were organised towards the end of the Stage 1 research.  Reports of these discussions are here:

Global Studies

Review of Research and Commentary on Social Movements Generally

We have reviewed the social movement literature focusing on some selected reports which are particularly relevant to our research objectives.  The full review is here: Review Social Movements Research and Commentary.

The most useful outcomes of this review of research and commentary is that it provides a vocabulary and snatches of theory which can help to extend discussion and deepen reflexivity within the movement. It certainly does not yield simple guidelines or principles.

The literature review presented in this annex was supplemented by the note on social movement theory in the Colombian Overview and Synthesis Report (ES, EN) and the literature review prepared for the Indian Report (here). Both of these reviews draw upon theoretical materials which are only briefly touched upon in this review.

Historical development of the global Health for All movement: continuity and convergence

The focus of this study was on the conditions for the emergence of a stronger globalised movement for health equity.  The researcher has assembled a collection of ‘episodes’ or ‘streams’ of civil society action around health with a view to learning about enabling conditions for movement building and in particular the patterns of influence through which different currents are coming together (or not) as a global social movement.  See full report of this study here.

Personal narratives of experienced activists

The aim of this project was to document the reflections of long term People’s Health Movement activists, in order to understand in a detailed way the motivations, dilemmas, experiences and learnings of activists and how they impact on the strategies and achievements of health activism.

Fifteen interviews were conducted; eight men and seven women from different countries across the world. All participants had long involvement in the global People’s Health Movement.

The methodology, findings and detailed analysis are presented in the full report here.

Manual on movement building

The manual on movement building was developed during the CSE4HFA research and published in April 2017.  Its development was based on wide consultation across PHM, including a wide range of case studies (summarised in the appendix), and was also informed by the emerging findings of CSE4HFA research. The Manual in full is here: Movement Building Manual (2017).

Evaluation survey of the International People’s Health University (IPHU)

This study involved a questionnaire survey of IPHU alumni conducted by a multidisciplinary team at the Centre for International Health in Bologna. The full report of the evaluation is here.

See also the report of the 2016 IPHU course in Nepal (here) and the report of the sequence of courses in El Salvador from 2012-2017 (here).

Evaluation of reach and impact of Global Health Watch 4

Global Health Watch presents an alternative discourse on health care and population health. It integrates rigorous analysis, alternative proposals and stories of struggles and change to present a compelling case for a radical transformation of the way we approach actions and policies on health.

It was first published in 2005 (here) and subsequently in 2008 (here) and 2011 (here). GHW4 was published in 2014 (here).  GHW5 was published in late 2017.

This evaluation of the reach and impact of GHW4 provides the opportunity to reflect on PHM’s approach to knowledge creation and dissemination towards Health for All.

The evaluation was based on a survey of anonymous respondents recruited through PHM’s Newsletter and collected through the PHM website and an anonymous survey of PHM activists who had been involved in organising launches of GHW4 in their countries at various different events.

Civil Society Engagement with Global Health Governance (GHG)

The Democratising Global Health Governance project was launched in 2010 by PHM in association with a number of other civil society organizations.  WHO Watch is a first step in implementing the objectives of the DGHG project.

This study involved an evaluation of the WHO Watch initiative report. The evaluation was undertaken in May 2015 and involved key informant interviews, focus group discussion, participant observations, and an online survey.

The evaluation report is here. See also the report of the Ghana Workshop (here) which provides a window on the local and national policy advocacy linked to WHO Watch. See also the personal reflections of a Brazilian watcher (here) on her experience engaging at the global and regional levels.

WHO Watch is very much about capacity building as well as engaging in global health governance.  The short online course (outline here) structured around global health governance and presented in 2012 and 2014 illustrates the capacity building side of WHO Watch.