Conflict and Social Transformation

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Nov 24, 2016 - one hour walking distance from her village. She has a big .... village people, comes back to his office and speaks jubilantly of "people's ...
Professor Madhusudan Subedi Central Department of Sociology Tribhuvan University, Nepal 24 November 2016

Basic Principle of Conflict  Positive Assumptions: • Conflict happens for a reason to cover up the changes that are needed • Conflict is normal in human relationships, and conflict is a motor of change

Transformation  •

Transformation has become increasingly common in both practitioner and academic circles.



Transformation provides a clear and important vision because it brings into focus the horizon toward which we journey – the building of healthy relationship and communities, locally and globally.



Transformation requires significant changes in our current ways of thinking and doing.

Discussion: A Story of 11 Years Girl Kamala Visited in a Health Post



 A 11 years illiterate girl Kamala visited in a Health Post, one hour walking distance from her village. She has a big cut on her foot, and visited the Health Post after 5 days. She is very weak and feels severe pain. She is the first child among 5 siblings and being from a poor family she has the responsibility to help her parents. She has a daily routine to go to forest with other villagers to collect firewood in the morning and looking after her brothers and sisters during the day.  Kamala’s parents are so poor and living in a miserable condition. They are not even able to sufficiently feed their kids despite their hard work. Sending her to school is out of the question.

Discussion: A Story of a 11 Years Girl Visited in a Health Post



Key Question: o Why did Kamala visit Health Post after 5 days? o Why was Kamala collecting firewood as such an early age? o Why don't her parents send her to school? o Why are her parents so poor? o But why? Causes of Causes ………..[social determinants of Health]

Key Issues: Social Transformation

  Immediate situation and management,  Deeper relationship pattern which goes beyond quick solution to the problem at hand,  A lens that helps us envision a framework the content, the context, and the structure of the relationship.

Views and Perspectives Macro



Micro

 Nepal: Constitutional Provisions, Policies and Guidelines

Right to health care as a fundamental right

Constitutional Provisions

Constitutional Provisions   Article 35 of the Constitution of Nepal, 2015 states: ‘Every citizen shall have the right to seek basic health care services from the state and no citizen shall be deprived of emergency health care.’  Additionally, it states that ‘each person shall have the right to be informed about his/her health condition with regard to health care services, each person shall have equal access to health care and each citizen shall have the right to access to clean water and hygiene.’

Constitutional Provisions 

 Article 38. Right of Women: Every woman shall have the right relating to safe motherhood and reproductive health (Article 38(2))  Article 39. Right of Children: Every child shall have the right to education, health care nurturing, appropriate upbringing, sports, recreation and overall personality development from family and the State (Article 39(2))  Article 40. Right of Dalits: In order to provide health care and social security to Dalit community, special arrangements shall be made in accordance with law (Article 40(3))

Constitutional Provisions   Article 42: Right to Social Justice: Citizens who are economically very poor and communities on the verge of extinction shall have the right to special opportunity and facilities in the areas of education, health, housing, employment, food and social security, for their protection, progress, empowerment and development (Article 42(2)).  People with physical impairment shall have the right to a dignified way of life and equal access to social services and facilities, along with their diversity identity (Article 42(3)).

Constitutional Provisions   Article 51. State Policies: The State shall gradually increase necessary investment in the public health sector in order to make citizens healthy (Article 51 (h) (5)).  Measures shall be taken to ensure easily available and equal access to high quality health care for all (Article 51 (h) (6)).

Health Policies and Plans of Nepal



First Long-term Health Plan (1975-1990)  A first Long Term Health Plan (1975 – 1990) was formulated with a calendar of operations for the Fifth, Sixth and Seventh Five Year Plans. The main emphasis was the provision of comprehensive basic health services to the majority of the rural population.

Health Policies and Plans of Nepal



National Health Policy (1991) The principal objective of the National Health Policy was to upgrade the health standards of the majority of the rural population by strengthening the primary health care system, making effective health care services readily available at the local level.

Health Policies and Plans of Nepal



Second Long-term Health Plan (1997-2017) The aim of the SLTHP was to guide health sector development in the improvement of the health of the population, particularly those whose health needs are not often met

Health Policies and Plans of Nepal



Health Sector Strategy: An Agenda for Reform, 20004 improve aid effectiveness by coordinating the efforts of Government and External Development Partners (EDPs) in support of a single Government-owned and led programme that aimed to put the country on track to achieve the 2015 Millennium Development Goals for health.

Health Policies and Plans of Nepal



 Safe Motherhood Program Since 2008, the GoN has also made institutional child delivery free for all women in all health facilities. The ‘Safe Delivery Incentives Program’ provided a lumpsum payment to offset travel costs to those who come to health facilities for delivery.

Health Policies and Plans of Nepal



 Free Health Service Program, 2007/08 Free health service program was implemented throughout the country by formulating, distributing and orienting Free Health Service Implementation Guidelines.

Health Policies and Plans of Nepal



Nepal Health Sector Programme Implementation Plan II (NHSP -IP 2) 2010 – 2015 The three objectives set out in the results framework are:  To increase access to and utilization of quality essential health care services;  To reduce cultural and economic barriers to accessing health care services and harmful cultural practices in partnership with non-state actors; and  To improve the health system to achieve universal coverage of essential health services.

Health Policies and Plans of Nepal

 Gender Equality and Social Inclusion Specific Strategies and Guidelines The government of Nepal has also issued some key guidelines and strategies on GESI such as:  Health Sector Gender Equality and Social Inclusion Strategy 2009  Operational Guideline for Gender Equality and Social Inclusion Mainstreaming Strategy in Health Sector 2013  Gender Equality and Social Inclusion Operational Guideline 2013

Health Policies and Plans of Nepal



Gender Equality and Social Inclusion Specific Strategies and Guidelines These guidelines emphasize creating a favorable environment, enhancing capacity of service providers, improving the health seeking behavior of disadvantaged populations based on a rights-based approach, ensuring adequate budget and monitoring arrangements

Health Policies and Plans of Nepal



National Health Policy 2014  Improve easy and free access of the disadvantaged and marginalized groups to medical services and treatment in local level health care centers and hospitals for 24 hours a day;  Provide disadvantaged groups with increased number of free medicines and free of cost maternity and child delivery services including from private hospitals;

Health Policies and Plans of Nepal



National Health Policy 2014  Create more vacancies for doctors in all district hospitals and first-aid health centers;  Launch campaigns like ‘Let’s have a doctor in our village' and 'health human resources for remote areas’; and  Install basic health laboratory test service in health centers.

Health Policies and Plans of Nepal



 Vulnerable Community Development Plan 2016 Respect the dignity, human rights, economies and cultures of vulnerable groups. The VCDP details agreed principles, guidelines and procedures to be integrated into project implementation that would ensure compliance with the applicable Nepali laws

Health Policies and Plans of Nepal



Policy on Quality Assurance in Health Care Services 2064 vs Policy:  Quality assurance will be developed as integral part of essential health care services delivery system.  A coordination mechanism will be developed among NGOs, private sector and local community to ensure quality health services delivery.  A sustainable standard will be developed from central to district in order to monitor the QA services;

A Bitter Truth: A Tight Schedule of a People’s Health Movement Practitioner



 7:30 am – 8:30 am Meeting with UASID (Discussion on project Proposal)  10 am – 11:00 am Meeting with World Bank Mission about Health Governance and Peace in Nepal  11:00 am – 3 pm (Regular Work at Office)  3:00 pm – 4:30 pm Meeting at Ministry of Health (Finalization of Drug Procurement Act 2016)  5: 30 pm – 6:30 pm Meeting - PHM, Nepal  7:00 Meeting with Health Minister about Dr Govinda KC’s demand

Discussion: Role Conflict

  Lack of conceptual clarity  Livelihood issues  Could not say ‘no’ to my colleagues  The concept was relatively progressive  ‘Something’ is better than ‘nothing’  Multiple role of an individual / professional  Xxxxxxxxx  Xxxxxxxx

 People’s Health Movement does not happen by accident. It needs a very careful planning and practices.

Case 2:   Mangri Health Post is located in a central point of 5 VDCs in Mugu district, Nepal. Discussion with community people and data from Health Post clearly indicate that many people visit to the private clinics and pay more but do not visit to the Health Post? Discussion: What are the reasons [in your opinion] for ‘not taking free services from Health Post’? You are, as an active member of PHM, requested to suggest appropriate intervention. What do you suggest for the betterment of Health Post?

People’s Participation  Everybody speaks of people's participation. A bureaucrat going into a rural area in his brand new imported jeep, and having a few words with the village people, comes back to his office and speaks jubilantly of "people's participation in planning". This is just poppy-cock. - Quoted in Peter Oakley et al. (1991). Projects with People. Geneva: ILO



People’s Health Agendas are periodically attacked by conservative leaders and professionals, and often ill-informed journalists and media commentators who desire to maintain the status quo. Overemphasized social categories: Caste/Ethnicity, Gender, Religion, Region Less emphasized but most important category: Social Class

Role of Foreign Experts   The role of the foreign experts in conventional development ideology is simple - and quite ineffective in bringing about social change. He or she has multiple constraints of culture, language, training and perhaps social class which make it difficult to work directly with the poor. It will always be easier to work with a narrow, westernized medical stratum who speaks the same language as the visiting health worker – literally and metaphorically. - David Sanders with Richard Carver (The Struggle for Health: Medicine and Politics of Underdevelopment.1985:218.

Agenda for People's Health Movement: The New Century



 Looking toward the next few decades, I see important conceptual, empirical, policy, and activist tasks for which the rich diversity of contemporary Population Health Professionals can work together for the better health of the general population.  These tasks should focus on equity and social justice

Key Issues   Bring Social Justice back to the Center,  Be more self-critical,  Recognize and stress the importance of discussing People’s Health – the health of disadvantaged

 Thank You

Time for Discussion [email protected]