PHM EVALUATION REPORT 2011
The evaluation was conducted from January to June 2011, by a team consisting of six members residing in India, Mexico, South Africa, Switzerland, Sweden, and Thailand. The evaluation was conducted through document review (global docs, evaluations, report, publications, etc), interviews and electronic survey questionnaires with the Steering Council, country focal points, IPHU alumni and faculty.
1. Do the current strategic objectives respond to the movement’s mission articulated by the People´s Charter for Health and other strategic documents?
PHM has over the years increased its reach and visibility and become a unifying movement around the ‘Right to Health’ and contributed to the renewal of thinking around ‘Health for All’ including social determinants to health. The People’s Charter for Health sets out an alternative set of values to the neo-liberal view of the world and calls on action on many fronts – it carries a strong symbolic value. Some would like to see PHM taking on more / different issues and some PHM activists don’t feel their voice is sufficiently heard at the global level, Not everyone puts effort into the global level advocacy. Local and global PHM advocacy initiatives could have more interconnectedness.
2. To which extent have the current PHM global programs, thematic circles, and other activities achieved the strategic objectives and responded to the PHM mission?
The movement has a number of global campaigns and programmes, the Right to Health Campaign (RTHC), the International People´s Health University (IPHU), the Global Health Watch (GHW), and WHO Watch. These have raised the profile and visibility of PHM. The RTHC and IPHU have reached out to new people and groups and been strong vehicles for dissemination of knowledge and building capacity of young and new activists. There is however a need for long-term planning and follow-up for those interested in PHM. The GHW receives strong appreciation from international activists, academics and government officials.
Thematic circles have functioned less well although some have gone through adjustments and are now considered global programmes, like the WHO Watch. PHM also partners with the World Social Forum in the vision that ‘another world is possible’. Communication tools like PHM-Exchange and the websites play an important role in sharing information and supporting networking. Most global programmes incorporate some gender analysis, but many would like to see this come out stronger.
3. To which extent has the current governance structure (including management system and financial controls) enabled the movement to achieve reasonable levels of inclusiveness and transparency?
A small group of committed individuals, most of them volunteers, has put in enormous efforts over the years to support the movement. These individuals, from diverse backgrounds and regions, are united by the core values of the PHM. There is overall agreement within the Steering Council that it is not functioning optimally in terms of accountability and that the SC needs a term limit for members. Limited communication within the SC and between the SC and the Coordinating Committee (CoCo), as well as with the rest of the PHM (including Country Focal Persons) has led to misunderstandings, under-appreciation and a perception of lack of transparency.
There is recognition of a generation gap and a need to include more women and marginalized groups in leadership. It is thus crucial that the action plan for a new governance structure is implemented as planned leading up to the People’s Health Assembly (PHA3). Further discussions on how to actively involve women and marginalized groups in leadership is needed.
The current three Global Secretariats (Cape Town, Cairo and Delhi) are well coordinated and many within PHM appreciate the new structure. Latin America has raised they would like to see the Global Secretariat being hosted in their region.
Financial controls and transparency have greatly improved in recent years
4. How effective are the current PHM strategies for managing the sustainability of human and financial resources?
PHM is very effective in piggybacking on other events and in its use of limited resources. The number of paid staff is kept to a minimum. However, the lack of regional administrative coordinators is making management less than optimal. Most programmes, as well as the PHM-Exchange depend heavily on one or two people, which is a risk factor and a lost opportunity to get more PHM members involved.
The IPHU has been one of PHM´s most important activities in the last years, but the lack of follow-up of alumni, as well as more concrete opportunities for them to get involved in limit its potential in recruiting active members. A notable exception is the African region which has employed a part time person to coordinate follow-up activities. Similar results are expected in other regions if resources were available.
There is a need for more clarity in terms of who raises funds for what. At both regional and national levels there are expectations, as well as uncertainties, over the role of fundraising from global. Although there is strong appreciation for volunteer work and it is considered normal that members of the movement contribute, the lack of funding is considered a challenge across the board. Changes in donor priorities and economic crises which decrease the availability of development funds pose real threats to the longer term financial sustainability of PHM.
5. Is the current geographical spread pertinent to carrying out the PHM mission?
PHM has a presence in all regions of the world. Many of those active in PHM work at the grassroots and PHM is therefore able to represent grassroots community health movements. There is, however, still potential to develop more global links with these grassroots health movements. PHM’s ‘presence’ in countries is not always at grassroots, but can also be concentrated on academics. Regional coordination is lacking in most regions resulting in a lack of planning. Language forms an obstacle for communications between regions, between countries and within countries. The digital divide is an important consideration when aiming to bring out the voices of the poor and marginalized, especially since much of PHM’s work relies heavily on online communications.
India and Latin America seem to be the strongest regions, although a decline in activities has been reported from India. Latin America has functioned more independently from PHM in other regions and from PHM global. The movement in Africa is young and less established, but growing.
In other regions, the Movement is patchy and is often represented by a few dedicated individuals who have direct contact with the global level.
6. To which extent is the PHM recognized as a global actor for change?
PHM has a genuinely good reputation globally where it is active. PHM messages ‘resonate’. PHM is known for its influence on the WHO Commission on Social Determinants of Health and has a visible presence at the World Health Assemblies. The Global Health Watch is well recognized by WHO, NGOs and some governments. Various other PHM publications, as well as articles in publications like the Lancet, contribute to the visibility of PHM and to the promotion of the message of ‘Health for All’. PHM’s analysis and health activism is increasingly incorporated into medical and health education and taken up by lecturers and students. However, global activities are not always grounded at the local level and the balance between ‘global’ and ‘local’ (or grassroots) needs to be better managed.
Suggestions and Recommendations
The following are suggestions and recommendations from the evaluation team with the aim of strengthening PHM´s impact as a global actor for change and from within the movement.
- To increase the breadth and depth of PHM as a movement and to strengthen its internal diversity. To embrace diversity is essential for ensuring credibility and sustainability. Globally, PHM should identify and apply better ways to represent the diversity of the movement in its governance structures, priorities, campaigns and working groups. In the regions, this will involve increasing outreach to other movements, activists and academics who share PHM’s core values and vision --and who can develop activities which are not current priorities of PHM. Concrete activities that bring together different countries and regions will naturally bring different strands of PHM together. It is important to consciously guard against sectarianism and exclusivism. IPHUs have a great potential to support movement building by running courses focusing on collective activism and advocacy.
- The governance structures --from the Steering Council (SC) to the national and sub-national coordination committees should be reviewed. It is essential to keep the current global secretariat functions and to ensure its capacity for strategic fundraising. However, the governance processes and representation should be made more inclusive and transparent. A system of ‘mentoring’ or ‘coaching’ could provide opportunities for newer and younger PHM members to become more active.
- The Gender Committee that that was established in 2010 by the SC should develop an action plan towards strengthening gendered perspectives and the inclusion of marginalized issues and concerns. While some of this is happening, there should be a stock taking of PHM initiatives that provide spaces for this and alternative new pathways.
- To strengthen participatory strategic development and planning. Prioritizing strategies and actions (campaigns, programmes, IPHUs, etc) at national and regional level, along with processes to decide if and what role PHM can play in campaigns. Interested IPHU alumni and PHM activists need to be offered concrete projects and/or campaigns to get involved in so as to make their participation in PHM active, meaningful and enduring. The African region has positive experiences of such involvement.
- Regional SC representatives need to be (s)elected and have support towork on outreach, networking and communication to support planning and activities including fundraising. A system is underway to make the (s)election of Regional SC representatives more participatory, inclusive and transparent. Organizing Regional PHAs could contribute to Movement building and solidarity.
- Environment and health: PHM is well placed to carry out in-depth, far-reaching research, awareness-building, campaigning, advocacy and social mobilising to curb the devastating effects on the health of people, on communities and climate change, as well as open pit mining and other transnational ‘mega projects’.
- Communication strategies for improved transparency. Regular summarized meeting minutes from CoCo and from the SC should be made available with the possibility for anyone to add their ideas and opinions. Information about the PHM (Charter, principles, activities, structure, functioning, etc.) should be disseminated widely and made available both electronically and in other ways.
- Communication strategies for improved networking. In order to improve PHM communications within the network and with interested ‘outsiders’, a list serve could be established in which people can select their areas of interest. Thematic discussions could be initiated through separate email groups, small skype sessions or internet discussion fora. It is recommended to create a PHM Global Communications Committee hosted in Latin America which, in collaboration with the existing web team, could enhance coordination regionally and in PHM globally through technological and electronic means.
- Develop local strategies that can influence WHO and global health governance. The WHO Watch initiative is promising. PHM should increase its emphasis on country circles (in its broadest definition) to better lobby WHO country representatives, as well as ministries of health.
- A permanent PHM presence in Geneva would greatly facilitate WHO lobbying. PHM is primarily reactive in most policy debates; while Primary Health Care and ‘Health for All’ were radical and proactive issues. It is thus recommended that PHM establishes some kind of “think tank” as a permanent observer of selected priority policy themes. This should be considered a long term goal given the current financial situation of PHM.