Just listen: research and activism can walk hand-in-hand

Real Health News

17 May 2006
Completing his three-year term as co-ordinator of the Global Secretariat of the People’s Health Movement – before it moves to the Middle East – activist researcher Ravi Narayan, a member of the Foundation Council of the Global Forum, speaks of the necessity for all groups working towards people’s health, including researchers, to listen to each other. Hard evidence is essential for progress he says – especially evidience collected and analysed by researchers in least developed countries.

RHN: Can you first tell us a little of your background?
Ravi Narayan: In the 1980’s, after WHO’s 1978 declaration of Health for All by the Year 2000 at Alma Ata, many people were working for Health for All; but NGOs, government, and researchers were all boxed up in their own little worlds, not talking to each other, not affecting each other.
So four or five of us in Bangalore, India, started the Community Health Cell (CHC) - now the functional unit of the Society for Community Health Awareness, Research and Action.
It’s a multidisciplinary group of professionals, based initially in Bangalore, but now in many parts of India. We all helped to build an interface between these three groups – NGOs, government and researchers - and amongst other things we built a People’s Health Movement (PHM) in India.
Some of my colleagues and I were very deeply involved the first international People’s Health Assembly in Bangladesh in 2000, and I was invited to continue to build such coalition in other places since 2003. That explains to some extent even my role now on the Foundation Council of the Global Forum for Health Research: my concern is to build linkages and dialogue,
RHN: You were also Professor of Community Medicine in Bangalore, and an Overseas Lecturer for the London School of Hygiene and Tropical Medicine. What research did you pursue?
RN: Well I was very involved with some pre-Alma Ata primary health care strategies - health cooperatives - and also in the tea plantation communities of South India. There we evolved something called the comprehensive labour welfare scheme.
These experiences and ideas contributed to primary health care thinking, and made the Indian Government very enthusiastic about being a signatory of the global Alma Ata Declaration when it came about in 1978. We had started all these in 1974, so we felt very endorsed by the Alma Ata declaration itself.
RHN: So these were effectively action research projects, were they?
RN: Yes, this was action research. We ran India’s first health cooperative - which was when we transplanted a health function to a milk cooperative in rural India, in Karnataka. The Indian Council of Medical Research selected it as one of the 14 alternative approaches to health care in 1976.
The second thing that I did was to set up a small occupational health unit, which focussed on agriculture. I did a very large study on tea plantation workers in South India, looking at potential occupational hazards. It was probably one of the largest studies on agricultural communities in the world.
Tea plantations are geographically well defined, so one can study health system development and epidemiological needs in a closed community.
So they’re ideal for research; but they’re also very useful and constructive, because you’re dealing with the plantation management - and by giving them evidence of what is happening you can try and build health systems that are more responsive to the needs of plantation labour.
At CHC we also researched TB in a very disadvantaged part of our state, looking at the social determinants and the health system issues that were making the TB programme unsuccessful.
The world was then moving to the new approach called DOTS – directly observed treatment, short-course. But in the social milieu of India, particularly in the disadvantaged rural areas, with our health systems being as they are, we felt DOTS would not be adequate. It was too biomedical and techno-managerial.
Our study was done by Thelma Narayan, presently the Coordinator of the CHC, and presented at the Global Forum for Health Research in Tanzania in 2002, where we showed a whole range of social, economic, cultural and political factors that determine the success of the TB programme. And we felt that if biomedical researchers don’t look at health system issues and social determinants, TB programmes would not really get far.
We’re quite thrilled with the fact that health systems research has now became a very important theme of the WHO - and I was honoured to be a member of its Task Force on the topic. We felt that in recent years some of the early research that we’d done, which was considered in a way marginal to mainstream research had now become mainstream.
Now health systems research and social determinants research are well recognized - and now we have a whole WHO Commission on Social Determinants with which many of us are also working closely.
The CHC basically focused on public health challenges and their social determinants and the health systems needed to address them. So you can understand why we are so thrilled with what’s now happening at an international level - and as a Global Forum Foundation Council member and in other capacities, I will try and push for health systems research and social determinants research in all health programmes.
RHN: Your research seems closely connected with pressure for change.
RN: I am an activist researcher. I am concerned about two global trends which I feel at present seem counter to the whole issue of looking at social determinants and health systems and I hope the Global Forum in Cairo in October will help to shift the balance a bit.
One is that donor funds still look at TB, malaria and HIV/AIDS as single vertical disease programmes. And no doubt they are very important diseases but if you go a little behind them, all three of them, you find health system issues and social determinants, which are cross cutting.
So whether you talk about development strategies or equity, gender, stigma or poverty or whatever, they affect all three and it’s important for the donors also to allow for projects that look at cross cutting, health system and social determinant themes rather than individual disease or health problems.
We hope that the WHO Commission on Social Determinants of Health will make a breakthrough on that.
The second trend is that there are groups like Gates Foundation who still are looking for drugs and vaccines - and we’ve been trying to suggest that existing drugs and vaccines that we have, and good ones at that, don’t reach the people they are supposed to reach. And so there’s absolutely no guarantee that you will be able to reach them with the new ones unless some of the funds, 10% maybe of the money, spent on research, is also be spent on finding why existing drugs and vaccines don’t reach the people.
RHN: Right, I understood. But let me be devil’s advocate. Isn’t the principal factor in this failure to reach the needy really political and economic? It’s not so much to be challenged by research, as to be challenged by political and community action.
RN: Well, I think that’s only partly true and I tell you why I say that. We need to look at social, economic, political and cultural determinants also as researchable evidence, not just as ideological positions…
RHN: I see, that is the point.
RN: There is a reason for that. There is increasing evidence all over the world in a lot of research, which is at present is not mainstream, but marginal, some of it from respected academia, not all from People’s Movements and Civil Society campaigns, that the existing vertical top down single disease strategies don’t work.
And they don’t work because these larger determinants have not been looked at adequately. And even groups like World Bank regularly generate data on these issues but sometimes tend not to use them.
For example, the World Bank has enough data to show that user fees don’t work anywhere, if you use access for poor people as an indicator. It’s maybe very good for a health system to generate some funds but if you use that as an obstacle for poor people to access whatever you want to distribute or provide, it’s definitely not a good idea.
So what would we call this? Economic evidence or an ideological position? I feel researchers must look at all the data and use the Cochrane Foundation type of approach asking, is there really evidence? [See our paper from the South African Cochrane Centre, RealHealthNews 5, 2006, pp 28-9.]
Everybody is also pushing public-private partnerships. There is no evidence than that public private partnerships support primary health care or public health goals. So why are we pushing a major policy shift in this direction? Where are public health programmes or primary health care programmes which are public-private partnerships, and which are working towards the Health for All goals? Because when you get private sector coming in with a profit motive, it will shift priorities.
I feel one of the roles I’m going to play now, as part of the Global Forum Foundation Council, is to provide or locate this sort of evidence - and to use hard evidence to challenge the system. So it’s not only the strength of people on the streets, or people demanding health for all as a right – but evidence that is also today on our side.
RHN: That’s the point you were making at the Global Forum in Mumbai in 2005 and I was very struck by that. But what do you mean by saying that this research is somehow not mainstream? Where is it being published?
RN: Well, it is being published, as reports by organisations, or in journals, but only on the sidelines. Let me give you one example. Some years ago I was asked by the Karnataka government, because they set up a health task force in the state, to look at externally funded projects. I looked at a combination of about 12 externally funded health projects. Karnataka, as you know, has a 55 million population, about the same as the UK.
There were World Bank, DFID and UNICEF programmes in TB, malaria and other diseases. The study looked at what these externally funded projects did to government health systems. We asked, through a participatory, interactive process: what do they do to sustainability and integration? Two very important issues.
My study showed that vertical programmes, when you have twelve like that coming to a state with each funding agency negotiating with the state with its own evaluation procedures, and its own schedules, the health system gets disintegrated. So most of it is unsustainable, because there are twelve systems rather than one integrated system.
Now this was reported and it helped Karnataka government make a decision. The 2001 WHO Commission on Macroeconomics and Health, chaired by Jeffrey Sachs, had a group, which looked at international funding, and they know about my study. It is included in the references - but unfortunately they didn’t take the recommendations seriously, just mention it in the reading list.
If they’d actually gone into that data they wouldn’t have made some of the recommendations they did. But groups like the Global Forum for Health Research, by facilitating researchers with such data available in the annual Forums, will slowly begin to change the balance.
RHN: So there may be two issues there. One may be that there’s not a critical mass, as such, of research and another might be that it’s being ignored for ideological reasons?
RN: Yes - I think they both are important. One is that most of the money is getting more and more linked to industry, and industry wants products, they don’t want processes - which they cannot own at some time and sell in some way.
Now I understand that that’s the way drugs and vaccines will develop. But if you say after studying non-communicable disease, that what you have to now do is to change people’s lifestyles, you can’t sell that easily. At the most you can produce a little manual on healthy living or something.
But commercially that’s a bit limited, whereas if you say that you take this pill and your stress will come down, that’s something you can sell.
So part of what you just asked was a clue, that research in those fields is not adequately funded because a lot of our funding is now coming from industry and we don’t have independent research from government bodies and from other networks that will look at health systems and social determinants. There’s no money in that.
Another problem is that a lot of researchers who understand health systems often also do a lot of single disease type of research - because that’s the way they can get some funds. And then they go to meetings, which are also single disease oriented.
So nobody is discussing health systems! Whereas if you actually went and listened to a conference on malaria and a conference on immunisation and a conference on TB, you find all of them are saying 'we are not able to transfer our ideas into the field because of health system issues, social determinants'. But then they won’t research it!
RHN: But you are actively promoting research in these areas, I understand?
RN: Well I’m trying an experiment in India, at the Dorabji Trust, one of our formal centres for infectious disease research, based in Bangalore – which is considered the science capital of India.
Of course our scientists in nuclear and space researchers there are better known than our health scientists, but we hold an annual meeting where they bring researchers in India from all over the country, around one disease. One year it’s malaria, one year it’s TB, and so on. This year it was HIV/AIDS.
Every year we facilitate one session on social epidemiology. So this year we brought along a few researchers in India who are doing work on a “social vaccine” for HIV/AIDS, so that in a highly biomedical conference, there was one session where people were presenting issues of stigma or poverty or gender.
In a conference that is primarily looking at new drugs and vaccines, the idea is to give researchers a feeling that these social questions are also important issues, and that it’s not for ideological reasons that we should look at them but just absolutely hard-boiled practical reasons.
You know, all these lovely new vaccines that are going to arrive will meet the same fate as the existing ones if we don’t tackle health system issues. The wider social determinants affect health problems and health systems, even more than the bio-medical determinants and someone has to support this research.
And research in the field on health systems and community is difficult – it’s more complex to organize, it’s not easy like in lab or institutional based research. The methodological, logistical, ethical issues are all complex.
RHN: And it requires a lot of sensitivity to the community, and knowledge of the culture.
RN: And even the methods of qualitative research – they also have to be strengthened. But there is an unwritten hierarchy in research that quantitative research for some reason is more fashionable or more scientific than qualitative research.
RHN: Let me ask you a question about how this information actually works. How it creates change. One thing that Regina Keith said to us when we were talking to her about her work with the Save the Children Fund was that she’s found that she needs to partner Southern research institutions with Northern, richer world research institutions if anybody’s going to listen to the results. This is not fair but it’s what happens.
She did a study in Sri Lanka, for example, on user fees and no-one took any notice. She presented at a side meeting at the Health Research Summit in Mexico in November 2004, but she feels it was ignored. So now she’s very keen to partner local research with research with another major institution in the North. Do you think that’s important?

RN: Well you see I would say yes and no. The PHM has been attending the Global Forum since Forum Five. In Geneva, in Forum Five, we presented the charter and what we thought were the messages for researchers from the charter. But from Forum Six, in Tanzania, we have always found researchers within the PHM network to come and present their data.
For example David Sanders came and presented some data on nutrition. Thelma Narayan presented data from her TB study on health systems and social determinants. And in Mexico, we had 18 members of PHM all over the place in the forum - and they made quite an impact, because they were all making the same case: that we’ve got the evidence, or we need support to collect this evidence but from what little we have, this is what we can conclude, and so on.
I think the important thing is to have research supported first; the second thing is, no doubt the funds are often with Northern institutions, and so you have to have Southern partners. My only worry is that that can be done in a way that fails to encourage the Northern and Southern researchers to dialogue and evolve research proposals around the table in an equal partnership.
We would tend to have Northern research centres working on social determinants using Southern researchers as the data collectors, or junior partners or field investigators. This would not build self-reliance or true North–South partnerships.
I think this is a whole question of solidarity. It’s important that the Southern researchers are not seen as field data collectors, and the Northern researchers as the ones with the computers and the programmes to analyse the data. It’s a joint activity, and it doesn’t matter whether it’s done in Sri Lanka or in the UK. I’ve never felt it’s a matter of North and South. I think it’s a matter of social determinants and health systems versus biomedical approaches.
So I’m not against North-South partnerships, but I only feel that very often because these proposals also get linked to finance with the North, there are very unequal relations. Southern researchers should also come to the Northern research centres, analyse and help with the interpretation - so that maybe at the end of the study you not only have a joint solidarity, but you also have a Southern researcher who can also handle data with the same amount of competence. It’s capacity building.
One of the present problems is that there is too much Northern capacity building and too much of pinching of Southern researchers, a whole brain drain from the Philippines, India, and South Africa into the research institutions - and no one acknowledges this.
A lot of good research in Northern academic centres is actually being done by [expatriate] Southern researchers. And a lot of good work is done in the South as well, by researchers facing phenomenal obstacles.
The case of [the economist] Amartya Sen is a good one. He won the Nobel Prize came for work he did in Delhi. Now he is in Harvard. But is he a Northern researcher or a Southern one?
RHN: There is of course enormous inequality within India. Do you think that the rural and the urban poor classes have stood up for themselves?
RN: Where in the world have you had a Coca Cola company being asked to close down? And World Bank pulling out of a large dam, except in India? Has it happened in USA or in UK or in Germany, or anywhere? Where have local illiterate village women lead a movement against deforestation? Policies have changed in India because of people’s pressure.
The present Government of India has now just launched a rural national health mission to train women health activists in primary healthcare. This is because PHM India led 300 activists to the parliament - and we raised pressure on political parties to introduce health into their agenda and make them part of the common minimum programme of the new coalition government.
RHN: So given some significant research, who do you need to influence to create change? Whose positions do you have to alter with the messages that come out of the kind of research you’ve been talking about? And what are the political obstacles to change?
When you’re talking about research to improve the delivery of physical products, like vaccines and drugs, then it would seem that you are moving along the same line as the manufacturing companies and all the forces for conventional economic development, so I would imagine that would be easiest to argue for. But if you have to talk about things like unequal treatment of farm labourers and so on, then you’re going to be on more difficult ground. What are you working against with the information that you gather through this kind of research?

RN: I think there are two levels at which to look at the issue. One is the type of research to be promoted, which we’ve talked about. The other is to bring that evidence to key policy makers and decision makers.
What is happening with the multinationals and the corporate sector, and the World Bank prescriptions, is product development and distribution. For example, the malaria research that we make so much noise about, it’s all bed nets, trying to get the whole of Africa under one single bed net.
But malaria is much more than bed nets. There are development strategies that are malariogenic, there are water management strategies, there are issues of poverty, gender and access.
Even if you had enough funds, all the crumbs from the rich man’s table, you wouldn’t still be able to bring a bed net to every African - because it’s not a question of distribution systems. It’s a question of social systems, it’s a question of geographical access, it’s a question of cultural traditions.
And if there’s no research on that, all you’ll end up with is mounds and mounds of bed nets all over Africa, supported by insecticide manufacturers and all the rest of them.
Meanwhile people are still getting malaria. So when someone like Thabo Mbeki [President of South Africa] talked about poverty being the cause of AIDS, he was laughed at because they said this is a Southern leader who doesn’t know that HIV virus causes AIDS. Nobody realised he was making a very philosophical statement: that you can’t get rid of HIV/AIDS in Africa unless you tackle poverty and inequity. And whether you tackle it by tackling the corruption of African governments or the biomedical orientation of international health agencies, or the global trade regime that impoverishes and destroys health systems, you cannot change that.
So I think the results of this kind of research have to go to everyone, and everyone has to understand that we are not taking an ideological position. We are using hard-nosed evidence, and for heavens sake just look at all the evidence around!
Look at the some evidence from World Bank, look at the evidence from studies, look at the evidence from all the PhDs that all these academics are doing. Why are we not taking them seriously? Because no-one wants to publish them. The whole process gets, in a way, loaded against qualitative, social determinants.
RHN: This sounds very depressing!
RN: I wouldn’t say it’s so bleak - I’m a great optimist. Some journals are reporting this, like the International Journal of Health Services, or Health Policy and Planning. All of them are beginning to publish social science and medicine.
So how do we get these journals to be read by the international health strategists? Well it’s also a problem of mindsets and worldviews. A biomedical worldview or a social/community oriented worldview!
But we also have to keep in mind that there are other interests - I am sounding like an activist when I say this! I mean there are global interests, which are against this view.
I’ll give you an example. One of the holy cows that we now have is the “pulse polio programme”. But groups all over the world at international and national levels have identified that one of the social effects of the pulse polio approach has been the marginalization of other childhood immunisation programmes.
RHN: What exactly are pulse polio programmes?
RN: A couple of decades ago we went to the community with the “expanded programme of immunisation”. This was based on data which showed that there were at least six diseases of children for which we have now enough vaccines, and the right ones, to give to all children of the world, to get rid of diphtheria, whooping cough, tetanus, polio, BCG and measles. So those were the six to target.
And we began EPI with WHO and UNICEF and governments and so on. But now suddenly, because of some data from a few researchers, we decided to mount a “pulse polio programme” where you repeatedly immunise children, not the usual three doses as part of repeated immunization programme, but as a sort of new focused initiative of immunization on specific days in year – in a sort of campaign mode.
This was not based on epidemiology but it was thought that if you want to reach everyone, you couldn’t do it through a regular programme of health workers visiting the villages or of people visiting clinics. So you have to have a campaign sort of approach several times a year.
And in short what it also meant was that it selectivises. The process picked on one disease, because pulse polio was an oral drop and some of the others immunizations are injectable. So they began this programme separately and then Rotary and the international agencies, foundations, and the whole world got into this.
And now all over the world WHO is supporting epidemiologists who are rushing round the countryside giving everyone polio immunization. Because they want to eradicate polio from the world. I’m not against that. But when you do it with such vertical zeal that the health workers are under pressure, there is all sorts of targeting, and all sorts of incentives, so that they now only concentrate on polio and they ignore the other immunization.
RHN: So you think it’s destroying it?
RN: David Sanders and I presented to Gro Bruntland in a WHO meeting, evidence from polio immunization that statistics had gone up. But at the same time diphtheria, whooping cough, tetanus statistics were coming down - and this was from WHO’s own sources. And we tried to explain that though we are doing a good job with polio, there was a responsibility for the human rights of others.
This is a health system research issue. It is not against one vaccine or the other. But it is saying that if you have six vaccines you want to deliver and suddenly you decide for some global, or whatever reason, to push one, you must push that in such a way that the other five don’t get ignored.
But pulse polio has become such a holy cow that nobody has the guts to publish data which shows the other immunisations are getting worse - and they are getting worse because you are pushing one vertically.
If you tried to publish that, they would say, no, no, you can’t put it in because we are on the verge of eradicating polio. And we don’t want any sort of negative messages.
Now I feel, there are human rights issues, because those children are entitled to the other five vaccines, not only one. And if WHO has set up epidemiologists who are on huge salaries, who are rushing around and as soon as the pulse polio is over, they stop that programme. Then what happens? The health system is not immunising other kids.
Recently a group in India raised this issue. They had a lot of difficulty; they’ve just managed to put their letter in the International Journal of Health Services. All we are trying to say is vertical programme affects other ongoing programmes, tomorrow it could be antiretrovirals for HIV, done with such a zeal that treatments for malaria and TB are affected because everyone is busy distributing ARV.
It is like inter-system research issues, cross-cutting determinants. If you say, no, no, you can’t publish that because you will now raise an unnecessary controversy then there is a sort of vested interest against that sort of research. And I believe this pre-occupation with biomedical techno-managerialism is itself ideological. And that’s what worries me a lot, that very often as soon as I put on my PHM hat they say “ideological!” and I say, no, let’s look at evidence. Don’t worry about my PHM hat; I’m also a researcher. Let’s look at social evidence, cultural evidence, economic evidence, and political evidence. You know, all the indicators you want and let’s mutually agree to study this together and analyse it together and let’s see what we conclude.
RHN: Let me ask you one last question. Since you’re leaving your role at the PHM, are you confident that the vision you’ve got about the value of research will be continued?
RN: Ah, yes, I think so because three interesting developments have taken place during my period in which I think there’s been a sort of institutional elevation of this whole idea.
One is the creation of the International People’s Health University. This was launched at the Second People’s Health Assembly (PHA2) by academics and researchers from all over the world. It will be soon be part of every People’s Health Movement. At regional or international conferences, a week before or after, like a satellite programme, it will train young activists in understanding this sort of evidence and research.
So we had 60 youngsters at PHA2 in Cuenca in Ecuador last July who came a week earlier, who looked at this evidence about globalisation and health and so on, and then formed themselves three small groups as a follow up activity. One group is going to continue to look at trade and health issues and evidence. Another is going to look at the success and failures of primary health care programmes. And another is looking at social determinants.
These are little networks of youngsters who are upcoming public health professionals or activists or researchers or whatever. They haven’t made up their mind where they fit in the system, but they all came to the assembly and were invited to come a week earlier. And we have just agreed to evaluate what has happened since they went home, and are working on how we continue this.
Secondly, with the Global Forum for Health Research, I managed for the first time at PHA2 to have a separate pre-assembly research encounter. It was called the Researchers’ Encounter where we invited researchers from the Latin American region, since we were meeting in Cuenca, to come together and have a workshop with academics and researchers who also belong to the movement. And a little booklet was released on that at Forum 9 in Mumbai in November.
This was a statement on research for people’s health, in English and Spanish, by PHM researchers and resource persons and local researchers and academics, supported by the National Association of the Faculty of Medicine in Ecuador, the Global Forum, Latin American Forum and so on.
But more local researchers need to come to our PHM assemblies so we can begin to look at evidence together. At the next People’s Health Assembly in Africa, some four years from now, there’ll be a much stronger involvement. There’s also been a lot of interest in People’s Health Assembly circles to also attend Forum meetings. So it’s working in each direction. The idea is that those people who are evidence collectors by design, by capacity, or by orientation, don’t have to feel that they can’t support the movement. The movement needs evidence and they can provide it.
And the third development, which is equally important, as you’ve reported in RealHealthNews 3, 2005, pp1-2, was the Global Health Watch process, an alternative World Health Report. We have just launched the process for Global Health Watch Two, which will be the second book. Already in the first one, out of 150 academics and researchers who contributed, you’ll be happy to know that only 25 had direct PHM linkages. Which means that already 125 academics and researchers in the world were willing to participate, and we hope that there’ll be a much larger number in GHW2.
We also had 30 researchers in Latin America putting together a Latin American version of the alternative World Health Report. Not just a translation. They did a sub-regional one. So my feeling is that, of course it’s a bit early, but it seems there are three or four places where evidence gatherers and movement activists can now actually dialogue.
And with my new hat as a member of the Foundation Council of the Global Forum and in other capacities, I’ll continue to push these dialogues. I feel it’s very important for the People’s Health Movement not to talk to itself, but to talk to other groups. My role now is to be a bridge builder.
We are also very actively involved in the WHO Commission on Social Determinants of Health. Fran Baum [a member of the Steering Group of PHM], from Australia, is one of the 16 Commissioners, and last July Michael Marmot, the Chairperson of the Commission, and a few other Commissioners came to PHA2.
Since then the Commission has signed a memorandum of understanding, an actual official document, with People’s Health Movements groups in Africa, Latin America, Asia and the Middle East, to be the Civil Society voice which brings research and evidence from Civil Society background, into the work of the Commission. And in every knowledge network we are now going to have a PHM representative whose primary responsibility will be to collect Civil Society evidence and voices, and collate evidence at the real level.
And as for where is all this being published, wherever it’s published someone now has to collect it and bring it to the notice of this Commission. We think it is a very exciting phase. I feel quite fulfilled in one way. Although policies are not yet changing at international level, I would say that in the last three years dialogue has begun. I understand that groups like RealHealthNews and others could help to promote such a dialogue.
RHN: Yes, I do take that point. And there are so many things to talk about, we’ve already spoken for an hour and we haven’t talked at all about the WHO discussion at the World Heealth Assembly on global R & D policy, and the need and possibility for a new “framework”. I don’t know whether you’ve got anything briefly to say about that.
RN: I wouldn’t want to say something straight away because we are trying to work on a position. But we recently circulated the PHM’s position on public-private partnerships. Again sometimes people think that PHM will just take an ideological position and that we are against public-private partnership. But it’s not for and against.
We think the private sector is an important sector in health, just as you have government sector and you have people’s sector, or Civil Society, but we feel that a partnership should be built around a framework of equality and dialogue.
At WHA, fundamentally we are taking the position that we want to strengthen WHO abilities of the international health level, because we feel all the global funds and large organisations are weakening their position. And we feel that as an inter-governmental organisation, and a UN organisation, it should be strengthened. But it must be strengthened with strong evidence, and dialogue with Civil Society.
Source: Real Health News - the newsletter of real action and research - No. 5 - May 2006

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