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  • Writer's pictureVijay Krishnarayan

Healthy discussion: but will Ministers listen?

Anton Kerr, former Director of HIV/AIDS alliance and chairman of Commonwealth Health Professions Alliance, makes the case for increased spending on health. Photo credit: Leo Kiss

But will Ministers listen? That was the thought that nagged away throughout the short flight from London to Geneva as I travelled to attend this year’s Commonwealth Heath Minister’s meeting. They meet in the wings of the World Health Assembly and we work to bring civic voices to that Commonwealth ministerial gathering. Naturally civil society organisations across the Commonwealth have an interest in trying to influence the outcomes of the ministerial meeting. To do this we convened a policy dialogue at the Commonwealth Civil Society Forum that addressed the themes that would come up in the Commonwealth Health Ministers Meeting, which met under the banner “Sustainable Financing of Universal Health Coverage as an Essential Component for Global Security Including the Reduction of All Forms of Violence. But would they listen?

I came away from Geneva understanding that I had been asking the wrong question. It’s not a question of getting ministers to listen – rather the challenge is getting ministers, officials and civil society to talk with each other in order to find workable solutions to the health challenges we face. The approach we took this year was two-fold.

Firstly, we broadened the debate so that a wider cross section of civil society was able to participate in the discussion. Not only did this bring a Commonwealth agenda to a new audience – it also provided an opportunity for voices less heard to be given a platform. We convened a working group comprising the Commonwealth Health Professionals Alliance, Third World Network and the International Community of Women Living with HIV in Eastern Africa so that civil society organisations were designing and steering the process. They also delivered the three policy papers that formed the basis of the discussions at the civil society forum. Those papers included policy asks of Commonwealth Ministers. Those policy asks drew on the inputs of more than 100 other civic voices from across the Commonwealth through a survey. The process also drew in new stakeholders.

Secondly we deepened the discussion so that Ministers were provided with perspectives from civil society that they might not have considered or previously been exposed to. The three papers explored each of the strands on the Ministerial agenda: adding a gender equality dimension; exploring the utility of the concept of well-being; and provoking a discussion on the financing of universal healthcare.

The papers stimulated discussion in different ways. The paper by Saamah Abdallah on the Politics of Wellbeing challenged conventional metrics of development. It posited wellbeing as a sustainable condition that enables the individual to develop and thrive. Its holistic approach encourages ministries and agencies to collaborate. In data collected to date it seems there is a correlation between high levels of wellbeing in a population and “good” governance. The paper on structural violence and its impact on women’s health was powerfully delivered by Lillian Mworeko. She cited instances of forced sterilisation of women living with HIV. She made the point that when institutions visit this violence on women they foster discrimination and stigma and this despite progressive laws and policies. Tony Nelson presented on financing Universal Health Care. The provocative thesis suggested that spending more on health care doesn’t always result in better health outcomes and that greater accountability is needed on way that resources are allocated and spent.

But would Ministers listen? The chances of giving the issues raised by civic voices a proper airing is constrained by the format of the Ministerial Meeting so we invited policy makers to sit with civil society at the Forum and respond to the policy changes being suggested. The Minister of Health for Barbados, Hon. John Boyce provided new insights on the potential of alliances between civil society and Ministries of Health. He described moves to address sugar in soft drinks in Barbados, where collaboration had worked well. Dr Jabbin Mulwanda, the Permanent Secretary for Health Services in Zambia affirmed how helpful civic inputs were for civil servants charged with finding solutions to public health challenges. Their willingness to engage at the Forum helped to achieve our objective of dialogue. Without them the Forum would have been one more civic gathering and there are plenty of spaces where civil society can talk to itself. I know colleagues from governments valued the exposure and I dare say we enhanced their Commonwealth Health Ministerial Meeting experience.

We provided a Commonwealth space that encouraged the co-creation of new policy thinking in a collegial and informal setting. We went some way to making room for less heard voices and south-south exchange. The process worked well and everyone got a boost from the attendance and participation of the Commonwealth Secretary-General, Hon. Patricia Scotland QC. It was the first time that an SG had actively listened to what civil society had to say about the Health Ministers’ agenda and her assurance that the policy asks made would be given proper consideration was widely appreciated.

But did Ministers listen? The crude indicator in these matters is the final statementthat Ministers issue at the end of their meeting. These statements are brief and summarise the main points. In the Commonwealth system they generally serve to signal intent rather than bind governments to specific commitments. Last year the Ministers’ statement included the line: “we note the civil society participation and contribution to discussions on sustainable financing and encourage their ongoing participation in health policy.” This was a disappointing result and perhaps responsible for that nagging refrain that wouldn’t go away – “Will Ministers listen?”

I looked at this year’s statement with hope restored. In paragraph 12: “Ministers noted the report from the Civil Society Forum Policy Dialogue which highlighted the need for a universal health system that provides basic minimum package of services to all as a key priority; emphasised well-being as core to health policy and being more than just absence of disease; and, raised the issue of structural inequalities and violence and their impact on the utilisation of healthcare.” This year it seems, at least the substance provided by civil society at its Forum had been registered.

Yes, Ministers of Health did listen to what civil society organisations had to say but now I was left with a new concern. If the priorities in the Ministers’ statement are going to be implemented – the position of Health Ministers in national administrations needs to be strengthened. My new question was “Does anyone listen to what Ministers of Health have to say?” Surely dialogue and alliances between health ministries and civil society for a common cause can only improve the chances.

This article was originally posted by the Commonwealth Foundation during Vijay’s time as the Director-General.

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