COPASAH Global Symposium 2019 On Citizenship, Governance and Accountability in Health 15-18 October 2019, New Delhi, India
The Alma Ata Declaration in 1978 with its call for ‘Health for All by 2000’ marked a new shared aspiration for all citizens to re-imagine the possibilities of reaching the ‘highest attainable standard of health’, articulated in the Universal Declaration of Human Rights (UDHR), as an achievable goal. A value framework of universality and equity with community as the central reference point were integrated both in positioning health as a human right along with proposing comprehensive primary health care as the pathway, as well as centre-staging community participation as one of the core principles.
Perspectives behind Themes of CoPGS2019: Citizenship, Governance and Accountability in Health
The health systems in developing nations include the public health systems as well as a whole array of private health care providers. The public health systems, which are constitutionally mandated to protect and promote wellbeing of communities are increasingly rendered fragile, weak, fragmented and shrunk. Alongside, the burgeoning private health care system has set itself progressively on the path of commercialization and corporatization, resisting its accountability neither to the constitutional principles nor to patients.
Community action in governance and accountability for health systems strengthening
The 1978 Alma Ata Declaration of Health located community participation as integral to redefining health as a human right for all and as a fundamental principle for achieving it through the pathway of comprehensive primary health care. The discussion on the universality of accessible and affordable care has continued through policy approaches such as Universal Health Coverage, Millennium Development Goals (MDGs) and SDGs.
Improving access to quality health services for the indigenous, excluded, vulnerable communities and those in fragile contexts
Several indigenous, vulnerable and marginalised communities, and those in fragile contexts such as those affected by conflict, displacement or natural disasters face exclusion and discrimination from the policies, programme and health care services. The modalities of exclusion, non-inclusiveness and discrimination are reflected in the health care programmes and policies that are designed and the kind of health care that is made available. It is estimated that 370 million indigenous people live in more than 70 countries around the world (WHO).
Moving forward the agenda for Sexual and Reproductive Health Rights
Sexual and Reproductive health rights are indivisible aspects of human rights, and deeply linked with the fulfillment of all other civil, political, economic, and social rights.
Global and national development agendas have over the past two decades, including as part of the Millennium Development Goals and thereafter the Sustainable Development Goals, included some focus on reproductive health concerns – particularly with regard to maternal health and family planning, sexual rights remain largely invisible.
Setting the framework and agenda for people centred accountability of private and corporate health care sectors
Globally, private and non-state actors are playing an increased role in global and national health policy making. Further in many low and middle income countries, the share of private healthcare provisioning has considerably increased. With the policy environment where States are promoting private health care at the expense of public health services, and in addition with advances in medical technology, the healthcare landscape is rapidly changing.
Forging alliances between community and health care workers
The health systems reflect the social hierarchies and hegemonies of power that are entrenched in the larger socio-political systems. Frontline health care workers – traditional birth attendants, community health workers (CHW), nurses and midwives the foundational building blocks of the health care systems. The community functions as a critical space for the interface of citizens (community members) and health workers. While some health care workers form the part of the formal health care system (such as nurses) others in several countries are either are not recognised or de-legitimised as in the case of traditional birth attendants in India.