Dialogue with civil society organizations (CSOs)
The participation of communities in defining health objectives and processes has been promoted by WHO for decades, starting with the 1976 Alma Ata declaration, which made participation a central feature of primary health care. In the 1980s, the emphasis on decentralizing health systems located the community as an important actor in organizing health sector interventions at district level. The further development of the concept of ownership, which is promoted vigorously in the United Nations Millennium Declaration, in Poverty Reduction Strategy Papers (PRSPs), Sector-Wide Approaches (SWAps) and in several other development assistance strategies, has strengthened the key issue of creating health and development "competent" societies that are able to interact effectively with governments, international organizations and donors.
At country level, CSOs participated in national commissions on macroeconomics and health (MH) in several MH countries, mainly in an advocacy and research capacity. Several countries have used the MH process to learn lessons from existing CSO experiences in health and development, adapt these experiences to the national context and identify modalities of interaction between governments and the civil society aimed at innovating the government's approach to investment in health for poverty reduction. This has been documented in Cambodia [pdf 104kb], Ghana, and India.
At regional level:
An Asian Civil Society Conference on Macroeconomics and Healthwas organized on 27 and 28 April in Colombo, Sri Lanka. The conference brought together some 60 representatives of local and international non-governmental organizations (NGOs) with activities in WHO's South-East Asia and the Western Pacific regions. The governments of 12 countries engaged in carrying forward the recommendations of the Commission on Macroeconomics and Health (CMH) were also represented in the conference, which examined how civil society organizations could contribute to improving the health of the poor within a macroeconomics and health framework. Working group discussions focused on the contribution of CSOs in four areas: policy debate and decision-making; increasing access to essential health services for the rural and urban poor; giving relief to households that experience catastrophic health costs; and analysis and strategic planning of macroeconomics and health issues through research. The conference has been successful in creating interest among local CSOs around macroeconomics and health issues in Asia, and reinforced the role of CSO in the ongoing national processes.
In the Eastern Mediterranean Region, the support to the follow-up to the CMH work and the MDGs has been closely linked to the activities with the civil society for the implementation of the Community-Based Initiatives.
Activities with CSOs within the MH framework at global level have so far focused on information exchange and advocacy meetings. Some health NGOs were involved in the CMH working groups process leading to the preparation of the CMH report. CMH findings and recommendations were also shared with the NGO community through a dedicated meeting organized in London in December 2001 on the occasion of the launch of the CMH report. In November 2002, the Dutch Royal Tropical Institute organized a Symposium on Macroeconomics and Health in Amsterdam. The participants included a considerable presence of mainly Dutch NGOs and research/academic institutions. The symposium further confirmed the need and the existing potential for a more important involvement of NGOs and civil society organizations in the follow-up to the work of the Commission on Macroeconomics and Health.
A well attended CMH briefing for country delegations and NGOs was conducted during the World Health Assembly in May 2003. The briefing offered a good opportunity to country delegations and NGOs to exchange information on the progress made in the MH follow-up at country level and better understand the requests and concerns of NGOs.
Exchange of experiences between CSOs have also been promoted on the MacroHealth website, to connect knowledge, lessons and resources from around the world. A web discussion was opened as a follow-up to the recommendations of the Asian Civil Society Conference that emerged from the working group 4 on the contribution of civil society to economic research. The discussion highlighted the need to ensure a better link between economic and macroeconomic studies to health and to encourage participatory research as a way to shorten the distance between people and international decision makers.