Putting people first? How can we as ‘project people’ become better at planning, implementing and stay accountable for ‘people-centred health care’?

HOW CAN THE SYSTEM PRODUCE BETTER HEALTH?

Never has there been as many ‘global health interventions in Sub Saharan-Africa, yet the health care system continue to fail the users, especially the poorest.

The state is loosing influence over the health care architecture and NGOs, foundations, public-private partnerships and research stations which combine data collection with provision of health care services are becoming more dominant.

The availability of pharmaceutical technologies, private funding and global mobilisation in favour of access to high quality health services as a right and not a privilege have never been higher.

WHERE DID LOCAL AGENCY AND SOVEREIGNTY COMPARED TO GLOBAL PRIORITIES GO?

Donor-agendasLocal agendas

• Infra-structure (roads & electricity)

• Chiefship • Witchcraft (new

forms of religious practice, e.g. Pentecostalism)

• Prevalent diseases (wounds, fever, children

that don’t develop age appropriately, childlessness)

• Food

• Human development (schooling & health)

• Democracy• Priority diseases

(mosquito nets, condoms, ARV, mass-treatment/LF)

• Target groupsYouth –over elders

Women – over men Girls – over boys

• Rights

WHAT ARE THE IMPLICATIONS OF ‘PROJECTIFICATION OF CARE’?

Donors look for problems within their frameworks and mandate (rather than for what’s people’s concerns);

The interventions to ‘solve the problem’ can easily be ‘magic bullet approaches’ where health promotion is narrowly promoted through the distribution of pharmaceutical technologies or products (condoms, bed nets, ARVs, food suplments, etc.)

WHAT ARE THE IMPLICATIONS OF ‘PROJECTIFICATION OF CARE’?

The ‘donor gaze’ on people can turn individuals into ‘target groups’ or ‘biological citizens’ (HIV+, pre-diabetics, future mothers, most-at-risk-populations, men-who-have-sex-with-men) rather than individual human beings living with a combination of characteristics;

Results are measured in terms of program success (e.g. compliance with standardized guidelines, number of drugs / vaccines / condoms / bednets distributed) rather than in health outcomes (survival / degree & sustainability of recovery);

A FEW PROJECT EXAMPLES WITH UNINTENDED CONSEQUENCES

Mass drug administration to interrupt transmission of lymphatic filariasis (elephantiasis) by the Tanzanian NTD programme (case shared by Britt Tersbøl).

Primary education in Togo (Piot C (2013) Nostalgia for the Future pp. 146-47)

PUBLIC HEALTH CARE RESURRECTION? Do we need a public

health care sector when transnational donors, faith based organisations, private-public partnerships and research stations that combine data collection with provision of health services are doing a job of a higher standard of quality or more ‘cost-effective’?

PUBLIC HEALTH CARE RESURRECTION?

• External funding come with vested interests which are not necessarily ‘putting people first’;

• Different kinds of responsabilities in public vs. Non-public sector towards the ultimate end-users

PEOPLE-CENTERED HEALTH CARE

What are the smaller, interim steps and actions that ‘project people’ can take rather quickly without waiting for high-level agendas to change in order to create conditions for more ‘people-centered’ health care?

Can NGOs work for / advocate for strengthening of public health systems?Can NGOs agree not to ‘lure’ local staff into projects?To support the MoH of becoming a strong priority-setter and not just a weak coordinator?Can NGOs abstain from creating parallel systems of health care delivery?Can NGOs focus health promotion on ‘the determinants of health’ rather than on the

HOW CAN WE BECOME BETTER AT WORKING WITH PEOPLE AS MORE THAN ‘PATIENTS’ OR ‘CLIENTS’ BUT RATHER AS POSITIONED SOCIAL ACTORS?

Always start with getting a picture of people’s real concerns inside and outside of your organization’s focus area/mandate.

In surveys: Rather than to ask for people’s relative wealth, ask how many people they know in a given network (the know-who capital).

Look at how your project contributes to / undermines existing primary public health care: does it fill out gaps or does it pull in a specific direction? Does it sustain health systems?

Bio-medical care through a health system is only a small part of what improves health – how can we see the wider picture?

THANK YOU

QUESTIONS FOR GROUP WORK

1. ‘Putting people first’ in project design: which types of questions can we ask if we want to know the target groups of our project interventions in more details than just their status/bio-sociality (as ‘HIV+/-’, ‘youth’, ‘mothers with young children’, etc.) – and who should collect that kind of data?

2. ‘Putting people first’ in project implementation: Which kinds of interventions should a project offer in addition to specific health technologies (ARV’s, condoms, mosquito nets, vaccines) and health regimens (counselling, information) to address people’s health concerns?

3. ‘Putting people first’ in accountability: Public health care workers are accountable to their state-employed regional supervisors in the country (+ to HC’s). ‘Project people’ are accountable to their donors outside of the country. How can NGOs become accountable to people on the ground?